HomeMy WebLinkAbout02-09-15 (2) ,��
ANNUAL REPORT OF " � �
� � � rn
p J.� n
-.r �TJ _� ^�
GUARDIAN OF THE PERSON `^' ;� � � ��� �
, ,_.._
_ ... ,
.. . .. ' CD � r.,:3
. , ,.:a
' ; '_:7 � _r1
COURT OF COMMON PLEAS OF � '' � ��3
: �-�
Cumberland COLTNTY PENNSYLVANIA � � ' _ r�'
' r�i C,�� �
ORPHANS' COURT DIVISION ►—' �`�
Estate of Gladys Shughart , an Incapacitated Person
No. 21-2013-1249
I. INTRODUCTION
Neighborhood Services , was appointed
�Plenary�Limited Guardian of the Person by Decree of Placey , J.�
dated March 31, 2014
� A. This is the Annual Report for the period from April 1 � 2014
to December 31 , 2014 (the "Report Period"); or
� B. This is the Final Report for the period from ,
to , (the "Report Period"), and is �led
for the following reason:
1. The death of the Incapacitated Person. Date of death:
2. The Guardianship was terminated by the Court by Decree of
J., dated
For u Finul Report, otrzit.S'ections II through IY.
V
Forni G-03 rev.10.13.06 Page 1 of 4 \,�
�\
Estate of Gladys Shughart , an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: 94 Date of Birth: 9/25/20
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
801 N. Hanover St
Carlilse,PA 17013
B. The Incapacitated Person's residence is:
0 own home/ apartment
�nursing home
�boarding home/personal care home
�Guardian's home/apartment
�hospital ar medical facility
�relative's home (name,relationship and address)
�other:
C. The Incapacitated Person has been in the present residence since Prior to
guardianship . If the Incapacitated Person has moved within the
past year, state prior residence and reason(s) for inove:
Forn:G-03 rer. 10.13.06 Page 2 of 4
Estate of Gladys Shughart , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Church of God Home
801 N. Hanover St
Carlilse, PA 17013
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Hyperlipidemia, Dementia, Alzhiemers, old myocardial infarction, atrial fibrillation,
diabetes type 2, vascular insufficiency
B. Specify what, if any, social,medical,psychological and support services the
Incapacitated Person is receiving:
24 hour supervised nursing care
Dr. Visits monthly
social work visits as needed
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
�continue
�be modified
�be terminated
Forn:G-03 rei�. ]0.13.06 Page 3 of 4
Estate of Gladys Shughart , an Incapacitated Person
The reasons for the foregoing opinion are:
We have not been notified by any doctor that she has an an improvement in capacity
B. During the report period, the Guardian of the Person has visited the Inc Person
2 times with the average visit lasting� hours,l5 minutes.
The f•eport of a social ser�vice organizatiorz ernployed by the Uuardiarz to oversee arid
coordinate the care of the Incapacitated Person fot�the period covered by thi.s Report may be
attached to szrpplement this Report.
I verify that the foregoing information is correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904
relative to unsworn falsification to authorities.
2/2/15
Date S tiire o ardr �he Persor
Neighborhood Service
Nume of Grrardian of Ihe Person/t�pe or'pr'inll
PO Box 1593
a�a���5�
Lancaster,PA 17608
Cit}',State,Zrp
717-392-2175
T elephone
For•m G-03 rev.10.13.06 Page 4 of 4