HomeMy WebLinkAbout06-18-15 (2) � i o � � �i. �
ANNUAL REPORT OF
GUARDIAN OF THE PERSON
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSY[,VANIA
ORPHANS' COURT DIVISION
;..,�
-�-, �
� :—�
Estate of Andrew M. Stern , an I�ca�acitate��ers�n�-`T'`,
�;� :: �.>
c= _
�a --�-s
r_.� � - , �.a
No. 21-11-0514 OC :' -� � ,_;
.
. .: .
_. �
„
�. , , _��_ - -,��,
- __ ; . ; .,._
:-,, . _. -� ,�-�>
_ . �_-�
_.._
. ._ f_,, (_:�
..,..,
_,...� __
r
_d- .-a ,.:>
.� c.t� `'�
I. INTRODUCTION
John K. Stern and Paula A. Stern , was appointed
�Plenary�Limited Guardian of the Person by Decree of Court of{..�'ommon Pleas �J.�
dated 17th day of June 2011
✓❑ A. This is the Annual Report for the period from 17 June � 2014
to 17 June , 2015 (the "Report Period"); or
❑ B. This is the Final Report for the period from ,
to , (the "Report Period"), and is filed
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., dateci�
For a Final Report, omit Sections II through IY. �\
Form G-03 rev.10.13.06 Page 1 of 4 �,
��
Estate of ��'ew M. Stern ��, an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: 27 Date of 13irth: November 08, 1987
III. LIVING ARRA1vGEMENTS
A. Current address of the Incapacitated Person:
984 Mt. Rock Rd.
Carlisle, PA 17015-9328
B. The Incapacitated Person's residence is:
�own home/apartment
❑nursing home
❑boarding home/personal care home
�Guardian's home/apartment
�hospital or medical facility
❑relative's home (name, relationship and address)
�other:
C. The Incapacitated Person has been in the present residence since August 1992
. If the Incapacitated Person has moved within the
past year, state prior residence and reason(s)for move:
Form G-03 rev. 10.13.06 Page 2 of 4
Estate of ��'ew M. Stern _, an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
John K. Stern and Paula A. Stern
984 Mt. Rock Rd.
Carlisle, PA 17015-9328
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Autism and Moderate Mental Retardation
B. Specify what, if any, social, medical,psychological and support services the
Incapacitated Person is receiving:
See Attached Sheet.
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
�✓ continue
0 be modified
0 be terminated
Form G-03 rev. 10.13.06 Page 3 of 4
� i o � ■ • . �
Attachment for Section IV B
Annual Report of Guardian of the Person of Andrew Stern,an incapacitated person,
No 21-11-05140C lune 17,2014.
Andrew Stern still resides at 984 Mt Rock Rd,Carlisle, PA 17015 with both his biological parents which
are his co-guardians. Andrew Stern still has Autism and Moderate Mental Retardation.
Andrew Stern continues to receive the Autism Waiver which entitles him to 40hrs/wk of community
inclusion,6hrs/wk of direct behavioral specialist,2.5 hrs/mth of behavioral specialist consults and
24hrs/mth of respite;these services are provided by Focus Behavioral Health of 639 Frederick St,
Hanover, PA, 717-668-3303. His supports coordinator for the Autism Waiver is Christy White of UDS,
1901 Olde Homestead Ln, Lancaster, PA 17605,717-847-7586.
Andrew Stern continues to see his medical doctor, Dr.Joseph Pion, Newville, PA for yearly check-ups
and any medical issues, Dr Killian of Carlisle, PA twice a year for teeth cleaning and dental check-ups, Dr.
Chotiner of Harrisburg, PA for yearly vision exams and to check bilateral lens implants,and Dr.Chris
Turnpaugh of Mechanicsburg, PA for neurobiological interventions using casein free-gluten free diet and
nutritional supplements.
Andrew continues to enjoy numerous activities:church,visits to siblings,grandparents and other
relatives, movies, Planet Fitness, library, bank,stores, parades,communit�r events,air shows,sporting
events,volunteer work, parks/lakes,and going out with friends with support staff or parents. He
continues to work every other week at Knisely's Pet and Farm.
Andrew Stern continues to need full time supervision and support for his own safety and well being.
We,lohn K.Stern and Paula A.Stern,think it is in Andrew Stern's best interest to continue the
guardianship.
� i n i � � . �
Estate of �drew M. Stem an Incapacitated Person
The reasons for the faregaing opinion aze:
Andrew Stern continues to need full time supervision and support for his own
well-being and safety. We,John K. and Paula A. Stem,think it is in Andrew's best
interest to continue the guardianship.
B. Di.u�ing the past year,fihe Guardian of the Person has visit�ed the Incapacitated Person
3b5 times with the average visit lasting 16 1laurs, minutes.
7'he report of a social service organization employed by the Guardian to oversee and
coordinate the care of the Incapacitated Person for the period cavered by this Report may be
attached to supplement this Report.
I verify that the foregoing information is correct to the best of my knowledge,
information and belief; and that#his Verificarion is subject to the penaities of 18 Pa. C.S.A. § 4904
relative to unsworn falsification to authorities.
'�/,,,
�
l� �� � �-_, :�
�nG
Date onati�re of Co-Gtrczr�fian o/'the Estate
Paula A. Stenl
, 984 Mount Rock Road
Carlisle, PA 17015
(717} 440-fi 163
� ,
7 ofs' ��`_�;''�.
L �
Da e 5igi atur e o j Cc�- ucu-dian of dte Estate `
ohn K. Stei�l\
984 Mount Rock Road
Carlisle, PA 17015
(717) 440,�.�t�� �Y`:; -:'°
Form G-03 rev. 10.13.Ob Page 4 of 4