HomeMy WebLinkAbout08-11-05
IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
INRE:
ORPHANS' COURT DIVISION
GENEVIEVE TRETTER,
No.
fAl-05-11\
AN ALLEGED
INCAPACITATED PERSON.
PETITION FOR THE APPOINTMENT
OF A PERMANENT PLENARY GUARDIAN
OF THE PERSON AND ESTATE
Filed on Behalf of Petitioner:
Beverly Healtbcare Camp Hill
Our Matter No. 121-05
~>
--,
f.-=--:'>
<:'J'-'
Counsel of Record for this P
U'l
ill
JL
_ Michael B. V olk, Esquire
. Attorney ID No. 88553
2933 North Front Street
Harrisburg, PA 17110
(717) 233- 4101
(717) 233- 4103
Attorneys for Petitioner
1
IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
INRE:
GENEVIEVE TRETTER,
) ORPHANS' COURT DIVISION
)
)
)
)
)
)
)
No.
AN ALLEGED,
INCAPACITATED PERSON.
PETITION FOR THE APPOINTMENT
OF A PERMANENT GUARDIAN OF
THE PERSON AND ESTATE ~
C) CJ
-- C) ,-~'-l
:'::1'"
_:,'--(}
-,
-::-J
, -
(.J
o
Petition For The Appointment Of A Permanent Guardian
Of The Person And The Estate Of An AIle2ed Incapacitated Person;.
;~
.-;..
AND NOW comes Petitioner, Beverly Healthcare Camp Hill, through their attol'lfey,
Doreena Craig Sloan, Esquire, and presenting this Petition to this Honorable Court for the
Appointment of a Permanent Guardian of the Person and the Estate of GENEVIEVE TRETTER,
an Alleged Incapacitated Person, representing as follows:
1. Petitioner, Beverly Healthcare Camp Hill is a nursing facility offering skilled care and
long-term care and is located at 46 Erford Road, Camp Hill, Pennsylvania 17011.
Petitioner is licensed to participate in the Medicaid and Medicare programs.
2. The Alleged Incapacitated Person is GENEVIEVE TRETTER a 97-year-old female
residing permanently at Beverly Healthcare Camp Hill. Her date of birth is November
27,1907. Her Social Security number is 168-24-7718.
3. Petitioner is an interested party because the Petitioner is currently providing long- term
care and nursing services to the Alleged Incapacitated Person. Petitioner has a statutory
and contractual obligation to act in the best interests of the Alleged Incapacitated Person.
6
:n
nl
C-,
o
.=-AJ
CJ
I ~ n,
C:J
S ,-~ ~i~
-n
;=)
rTl
,J)(J
-1.1
4. The Alleged Incapacitated Person was admitted to Beverly Healthcare Camp Hill on
January 31, 1995.
5. The Alleged Incapacitated Person is diagnosed with Senile Dementia and Cardiovascular
Accident.
6. The Alleged Incapacitated Person has never served in the Armed Forces of the United
States of America.
7. The Alleged Incapacitated Person does not generally comprehend her surroundings to
such an extent that she requires consistent supervision in her activities of daily living. As
a result of her condition, the Alleged Incapacitated Person requires specific one-on-one
assistance with grooming, transferring, ambulation, toileting and bathing.
8. The Alleged Incapacitated Person is incapable of handling her personal affairs, however
minor, and if called upon to grant informed consent to any medical procedure she would
be unable to grant it because of her inability to comprehend the nature of the procedure.
Additional information is set forth in the competency affidavit, prepared by her treating
physician Dr. James Harty, 207 House Avenue, Cumberland County, Camp Hill, and
incorporated by reference attached hereto, and marked Exhibit "A."
9. The Alleged Incapacitated Person is not expected to recover from her current condition to
become sufficiently independent to return to the community.
10. After reasonable investigation Petitioner has determined that the Alleged Incapacitated
Person has no living next of kin or interested party.
II. After reasonable investigation, Petitioner can find no other individual willing to act as
Guardian for the Alleged Incapacitated Person.
7
12. There is no existing Power of Attorney from the Alleged Incapacitated Person to anyone
authorizing them to make decisions regarding the person or estate of Genevieve Tretter.
13. The Alleged Incapacitated Person has limited assets that consist chiefly of Social Security
Pension in the monthly amount of $1,134.56. Her Social Security is being managed by
Petitioner for her care.
14. Petitioner requests the Guardian be assigned the following powers below described:
a. Making Medical decisions, which would include but not be limited to:
I. medication, antibiotics, hydration, tube feeding, respirator use;
11. situations related to the active dying process;
iii. hospice selections;
IV. selecting or replacing the attending physician;
v. skilled care and acute care placement;
b. Maintaining order in the financial affairs ofthe Alleged
Incapacitated Person, which would include but not be limited to:
I. establishing the guardianship bank account;
ii. marshalling the alleged incapacitated person assets;
Ill. paying bills for the alleged incapacitated person, including
bills for nursing care and services;
IV. making bank deposits;
v. writing checks for expenses;
VI. performing all other acts necessary to avoid waste with
respect to the assets of the alleged incapacitated person.
15. Petitioner knows of no available less restrictive alternative to the establishment of a
Permanent Guardian of the Person and Estate ofthe Alleged Incapacitated Person.
16. The Proposed Guardian is Patricia Maisano as Founder and Principal of IKOR, Inc.,
and/or Cassandra Hill, an employee of IKOR, Inc., located at 31 Eagle Lane, Reading,
Pennsylvania 19607, which for a fee provides Guardianship services to persons in need of
such services.
8
17. Patricia Maisano, Cassandra Hill and IKOR, Inc., having no interest adverse to the
Alleged Incapacitated Person, has agreed to act as Guardian of her Person and Estate if
this Honorable Court shall so appoint. The executed Consent of the Proposed Guardian
is attached to this Petition and marked Exhibit "B."
18. Neither Petitioner, nor Proposed Guardian, is related to the Alleged Incapacitated Person
nor does either have an interest in the estate of same.
19. If appointed by this Honorable Court, the Guardian will act in compliance with
regulations promulgated under Court Order in Pennsylvania Bulletin 931, et seq., April
19,1975.
20. An Application for Medical Assistance has been approved by the Department of Public
Welfare for GENEVIEVE TRETTER.
21. As a Medicaid recipient, the Alleged Incapacitated Person is required to maintain total
assets of not more than $2,500.00.
22. As a Medicaid recipient, the Alleged Incapacitated Person will receive a personal
allowance of $30.00 a month.
23. The Alleged Incapacitated Person's funds are maintained in a resident fund at Beverly
Healthcare Camp Hill and the balance is approximately $423.00
24.20 Pa.C.S.A. 95515 states "... provisions relating to a guardian of an incapacitated
person and her surety shall be the same as are set forth in the following provisions of this
title relating to a personal representative or a guardian of a minor and their sureties:..."
Section 5122 (relating to when bond not required).
25.20 Pa.C.S.A. 95122 (d) states "in all other cases, the court may dispense with the
requirement of a bond when, for cause shown, it finds that no bond is necessary."
9
WHEREFORE, Petitioner respectfully requests this Honorable Court to:
1. Award a Citation directed to GENEVIEVE TRETTER and others as the Court sees fit to
show cause why GENEVIEVE TRETTER should not be declared an incapacitated
person and why a Permanent Guardian of her person and Estate should not be appointed;
2. Appoint Patricia Maisano as Founder and Principal of IKOR, Inc., and/or Cassandra Hill,
an employee ofIKOR, as Permanent Guardian of the Person and Estate of GENEVIEVE
TRETTER.
3. Dispense with the requirement that the Proposed Guardian obtain a
lchael B. Volk, Esquire
Attorney ID No.: 88553
2933 North Front Street
Harrisburg, PA 17110
(717) 233- 4101
Attorneys for Petitioner
D~:/~~~~~~
10
IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
INRE:
) ORPHANS' COURT DIVISION
)
) No.
)
) PETITION FOR THE APPOINTMENT
) OF A PERMANENT GUARDIAN OF
) THE PERSON AND ESTATE
)
GENEVIEVE TRETTER,
AN ALLEGED
INCAPACITATED PERSON.
JUN 1 J 2005
VERIFICATION
AY)~V)etf-e 6LJ4/J{ - -Scn&J )Jilt
I,
am an authorized
representative of Beverly HeaIthcare Camp Hill, Petitioner in this matter, do hereby depose and
state that the facts contained in the foregoing Petition are true and correct to the best of my
knowledge, information and belief. I understand that false statements made herein are subject to
the penalties of 18 Pa.C.S.A. Section 4094, relating to unsworn falsification to authorities.
Date: ci ff /0')
g/l ~ #1#
everly Healthcare Camp Hill
11
IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
INRE:
) ORPHANS' COURT DIVISION
)
) No.
)
) PETITION FOR THE APPOINTMENT
) OF A PERMANENT GUARDIAN OF
) THE PERSON AND THE ESTATE
)
GENEVIEVE TRETTER,
AN ALLEGED
INCAPACITATED PERSON.
CONSENT OF THE PROPOSED GUARDIAN
I, (life,;" 0 Sloe".) , am an authorized representative of Faith, Hope and
Love Guardianship Services, Inc., and do hereby certifY we are willing to act as the Permanent
Guardian of the Person and Estate of GENEVIEVE TRETTER, if the Court shall so appoint us.
Further, I do hereby certifY that I am not a fiduciary of any estate in which the alleged
incapacitated person has an interest, nor have I any interest adverse to the alleged incapacitated
person.
The facts and opinions contained herein are true and correct to the best of my knowledge,
information and belief.
/-;/ ~'11 65
. J
Date
Fai~ and~~shiP Services, Inc.
Sworn to and subscribed before me this
d qttl day of ----BPI I I ,2005.
~~;"cF-cL)
My Commission Expires:
0,-7- 0<;5
COMMONWEAl. TH OF PENNSYLVANIA
NalIItII Sell
Klnn LcUIe FIIIw, Nl8Iy NlIc
Clly 01 HIIIIIIug. DIupIilOclll1lv
My 001'01"'1 E,.,n..u.e 7. 211118
_. Ponnsylvonill"._OI_
EXHIBIT
I
17
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHAN'S COURT DIVISION
IN THE MATTER OF GENEVIEVE TRETTER,
an Alleged Incapacitated Person No.
: Petition for the Appointment of a Permanent
: Guardian of the Person and Estate
Affidavit of Dr. James Harty in Support of Petition to
Adiudicate GENEVIEVE TRETTER, an Alleaed Incapacitated Person
1. My name is Dr. James Harty.
2. My occupation is as a physician.
3. My business address is 207 House Avenue, Camp Hill, PA 17011.
4. My educational background is as follows:
a. State Medicall Graduate School
Medical College of Virginia
b. State Undergraduate
University of Illinois
5. I am licensed by the State of Pennsylvania as M.D.
5. I specialize in Private Practice.
6. I am affiliated with Beverly Healthcare Camp Hill
7. I have been affiliated with Beverly Healthcare Camp Hill since December 3, 2002.
8. I first met GENEVIEVE TRETTER in October 2003.
9. I last met with GENEVIEVE TRETTER on February 24, 2004.
10. I last reviewed GENEVIEVE TRETTER'S chart on February 24,2004.
11.
GENEVIEVE TRETTER'S pertinent diagnoses are:
Cardiovascular Accident
Senile dementia and
EXHIBIT
12
I
25. GENEVIEVE TRETTER'S limitations relevant to this guardianship proceeding are not
likely to improve neither in the immediate future nor over time. To the extent relevant change
is likely, it will be, in my opinion, expressed with reasonable medical certainty, for the worse.
26. I have been made aware of the statutory definition of "incapacitated person" under
Pennsylvania law.
27. My opinion, based on my examinations of GENEVIEVE TRETTER and my review of her
medical records, expressed with reasonable medical certainty, is that GENEVIEVE
TRETTER is totally incapacitated as to matters affecting her person.
28. My opinion, based on examinations of GENEVIEVE TRETTER and my review of medical
records, expressed with reasonable medical certainty, is that she is totally incapacitated as to
matters affecting her financial affairs.
29. Based on the opinions that I have expressed, my opinion, expressed with reasonable medical
certainty, is that GENEVIEVE TRETTER requires the appointment of a guardian of her
person and estate.
30. My opinion is that GENEVIEVE TRETTER could possibly be harmed if she were required
to attend her guardianship, however, I feel this point is moot because GENEVIEVE
TRETTER would not be able to contribute in any way to the hearing.
31. My opinion is that MARGARET P. BOYER would not understand nor benefit from participation
in a court hearing regarding a determination of her capacity to handle her own personal and
financial affairs.
14
12. GENEVIEVE TRETTER currently takes the medications on the list attached to this
Affidavit.
15.
GENEVIEVE TRETTER prognosis is: poor fair
good
16. The extent of GENEVIEVE TRETTER'S ability to communicate is as follows:
a. Verbally poor fair good
b. In Writing poor fair good
c. Other Means poor fair good
17. The extent of GENEVIEVE TRETTER'S ability to receive information is as follows:
a. Reading: poor fair good
b. Hearing: poor fair good
18. GENEVIEVE TRETTER is capable of independently performing ONLY the following
activities of daily living.
a. Eating
b. Grooming
c. Ambulating
d. Toileting
e. Transferring
19. GENEVIEVE TRETTER has emotional limitations in the form of:
20. GENEVIEVE TRETTER is ABLE to interact socially on any meaningful level.
If ABLE, then please describe:
21. GENEVIEVE TRETTER does not generally comprehend her surroundings to such an
extent that she requires consistent supervision in her activities of daily living. As a
result of her condition, she requires specific one- on- one assistance with grooming,
transferring, ambulation, toileting and bathing. She absolutely could not manage any
of her own activities of daily living without supervision or assistance. T/F
22. GENEVIEVE TRETTER IS NOT capable of handling her financial and personal affairs,
however minor. She requires total assistance in these areas.
23. GENEVIEVE TRETTER, if called upon to grant informed consent to any medical
procedure, however minor or straightforward, would be unable grant it because of her inability
to comprehend the nature of the procedure.
24. GENEVIEVE TRETTER absolutely cannot actively and effectively participate in monitoring
and managing her own medical care and medication. She requires supervision in this area.
13
I, Dr. James Harty, being duly sworn according to law deposes and says that I make this Affidavit
on behalf of MARGARET P. BOYER and that the facts set forth in the foregoing Affidavit are true and
correct to the best of my knowledge, information, and belief.
I verify that the statements in this Affidavit are true and correct. I understand that false statements
herein are made subject to the penalties of 18 Pa.C.S.A. 94904 relating to unsworn falsification to
authorities.
Dr. James
Date: {",.- 11 ,,~
Sworn to and subscribed before me this Of,3/os
daYOf~ ,2005.
~~ P1o*
My Commission Expires:
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Ginger A. Sergott. No~ Public
City of Harrisburg. Dauphin County
My CommissiOfl Expires Sept. 13.2008
Member. Pennsylvania Association of Notaries
15
PHYSICIAN ORDERS
FACILITY
CYCLE START
CYCLE END
BEVERLY HEALTHCARE - CAMP HiLL
6/1/2005
6/30/2005
DIC
ORDER DATE
ORDER CODE
TIME
ORDER TEXT
DESC_ TeXT
*********** ************* *****************************************
* This r sident zequir~s continued NURSiNG CARE SERViCES *
* May di continuE any ~RN MED/TX not used in 60 days *
* Generi s substltuted unless noted "DiSPENSE AS WRiTTEN". *
* i appr ve overell pl~n of care, iDCP, and discharge plan *
*********** *******~***** *****************************************
4/28/1997 Ancill
PROGNOSiS: GOOD
1/31/1995 Ancill
May participate in activities per plan
of care.
1/31/1995 Ancill
Resident &/or responsible party has
been informed as to condition &/or
diagnosis.
1/31/1995 Ancill
Resident is free of communicable
disease.
1/31/1995 Ancill
MOBiLiTY: AS PER PLAN OF CARE
12/12/2001 Ancill
PSYCH CONSULT RE: BEHAViOR
3/26/2004 Ancill
CONTiNUE WiTH PSYCHE FOLLOWUP AS NEEDED
6/30/2004 Ancill
appt w/ kekstone urology for consult on
june 7th 05 @ 2:30pm w/ dr moyer - 645
12th st , suite 300 , lemoyne , pa (
763-7037)
1/22/2004 Resusc
CODE STATUS/ FULL CODE
4/29/2005 SRail
SHiF transfer bars to be in upright L
position at all times to aide in
repositioning while in bed every shift
4/4/2005 Posit
SHiF Pressure reducing Mattress to bed.
* i have
* Physic
* Licens
*_._.---**.
*************
*******111****_
*******'llI*****
reviewec & ap
an Signeture:
d NUrse Signa
*******i*****
*****************************************
*****************************************
***********
***********
***********
;:::*:~~*:;~:;::*****(j*********:::::~*~:;'O ~
ure: Date: *
********************** ****************** I
NURSiNG ALERT:
PHYSICIAN
I PHONE NO.
-r.;-,'7_'7",_A....,
I
I ~.
ALTERNATE PHYSICIAN
I PHONE NO.
1'71 '7_"''',_A....,
"'& -....
DIAGNOSES
ALLERGIES
436. CVA (Cerebrovascular Accident) -- 294.8
ORGANiC BRAiN SYND NEC -- 443.9 PERi PH VASCULAR
DiS NOS -- 593.9 RENAL & URETERAL DiS NOS
682.6 CELLULiTiS OF LEG
MEMBUTAL
NAME
Tretter Genevieve E
RECORD NO. I LOCATION BIRTHDATE T AGE I ADMIT DATE
90959 12-00113-A 11/27/19071 97 11/31/1995
POFORM
I PAGE
11
PHYSICIAN ORDERS
FACilITY
CYCLE START
CYCLE END
BEVERLY HEALTHCARE - CAMP HILL
6/1/2005
6/30/2005
ole
ORDER DATE
ORDER CODE TIME
ORDER TEXT
DESC.TEXT
8/13/2003 Posit SHIF KEEP LEGS ELEVATED WHEN NOT AMBULATING
every shift
7/29/2004 alarms SHIF Wanderguard Alarm Sensor to be on at
all times check placement &function
every shift
11/1/2000 Diets
May have fortified foods
2/10/2005 Diets
NO SALT PACKET
11/9/2001 Suppl
QID
MED PASS 2.0 - GIVE 2 OZ four times per
day
8/26/2004 Suppl
TID
House supplements TID due to 98% weight
loss in 90 days and eating poor at
meals Oral three times per day
(SUPPLEM)
9/3/1996 Meds
QWK
CHECK A/P Q WEEK 7-3 WED
AP
1/31/1995 Meds
PPD Yearly
JANUARY
2/3/2000 Meds
QD
NOLVADEX TABS, 20MG (TAMOXIFEN
CITRATE/20MG) 1 TAB = 20MG Oral daily
for 239.3 Neoplasms of unspecified
nature, breast
3/7 /2000 Meds
QD
PRINIVIL TABS, 10MG (LISINOPRIL/l0MG)
TAKE 1 TAB PO Q DAY for 401.9 Essential
Hypertension, unspecified
1/8/2003 Meds
CHECK PLACEMENT OF ID BRACELET QS TO
INCLUDE ROOM NUMBER, RESIDENT NAME,
FACILITY NAME AND PHONE NUMBER REPLACE
BRACELET IF NOT INPLACE/ CHECK RESIDENT
PICTURE NOTIFY 7-3 SHIFT TO TAKE
PICTURE VIA 24HR REPORT
*********** *************~*****************************************
* I have reviewec & approve all orders: 1 * ;
* Physic an Signature: Date:(., ('''(*-ti....r
* Licens d Nurse SignaFure: Date: *
*********** *******i*****~********************* ******************
NURSING ALERT:
PHYSICIAN
I PHONE NO. I ALTERNATE PHYSICIAN
1'7''7_'7'" _11......, 1 Y..a'-~
I PHONE NO.
1'71'7 _'7'" _II'" ~ 1
DIAGNOSES
ALLERGIES
436. CVA (Cerebrovascular Accident) -- 294.8
ORGANIC BRAIN SYND NEC -- 443.9 PERI PH VASCULAR
DIS NOS -- 593.9 RENAL & URETERAL DIS NOS
682.6 CELLULITIS OF LEG
MEMBUTAL
NAME
Tretter Genevieve E
I RECORD NO. I LOCATION BIRTHDATE I AGE I ADMIT DATE
190959 12-00113-A 11/27/190'li 97 11/31/1995
POFORM
I PAGE
12
FACILITY CYCLE START CYCLE END
--
BEVERLY HEAIIl'HCARE - CAMP HILL 6/1/2005 6/3012005
DIG ORDER DATE ORDER CODE TIME ORDER TEXT i DESC_ TEXT
9/1712003 Meds INFLUENZA VIRUS VACC TRIVALENT SUBV !
(INFLUENZA VIRUS VACCINE)0.5 CC X 1
DOSE RECORD SITE Intramuscular ANNUALLY
12/1/2003 Meds QD LASIX 40 MG Oral daily for 682.6
Other cellulitis and abscess, leg,
except foot, LLE I
7/30/2004 Meds HS ARICEPT 5 MG 1 TAB (Donepezil
Hydrochloride) Oral every evening at
bedtime for 290.0 Senile and
presenile organic psychotic conditions,
senile dementia, uncomplicated
512012005 Meds QD DETROL LA 4 MG CER (Tolterodine
Tartrate) ONE TAB Oral daily for 593.9
Other disorders of kidney and ureter,
unspecified disorder of kidney and
ureter
1/1012002 AntiDP HS TRAZODONE 50MG TABLET (TRAZODONE HCL)
GIVE 1/2 TAB = 25MG Oral every evening
at bedtime for 311. Depressive
disorder, not elsewhere classified
5/5/1998 pain HS TYLENOL TABS, 325MG
(ACETAMINOPHEN/325MG) 2 TABS = 650MG PO
AT 9PM 2 TABS=650MG. for 354.0
Mononeuritis of upper limb and
mononeuritis multiplex, carpal tunnel
syndrome Check scheduled and pm doses,
do not exceed 4gm in 24 hr period. i
9/6/1999 vitam. QD POTASSIUM CHLORIDE TABS CR, 10MEQ
(POTASSIUM CHLORIDE/l0MEQ) 1 TAB PO
QDl TAB Oral for 401.9 Essential
Hypertension
*********** *******,. ***** *****************************************
*********** *******,. ***** ***********************~**************
* I have reviewec & ap ~rove all orders: 4 * v
* Physic an Signa ture: Date: f{'1!</IS'v
* Licens d Nurse Signa I'ure: Date: *
*********** *******,. ***** *****************************************
NURSING ALERT:
PHYSICIAN T PHONE NO. 1 ALTERNATE PHYSICIAN I PHONE NO
1'71 '7_'7"'_D~~' 1 .....~,-~ !717_7,,'_a~~'
DIAGNOSES ALLERGIES
436. CVA (Cerebrovascular Accident) -- 294.8 MEMBUTAL
ORGANIC BRAIN SYND NEC -- 443.9 PERIPH VASCULAR
DIS NOS -- 593.9 RENAL & URETERAL DIS NOS
682.6 CELLULITIS OF LEG
NAME 1 RECORD NO. I LOCATION BIRTHDATE I AGE I ADMIT DATE 1 PAGE
Tretter. Genevieve E 190959 12-001l3-A 11/27/190'li 97 11/31/1995 13
PHYSICIAN ORDERS
POFORM
FACILITY CYCLE START CYCLE END
BEVERLY HEALTHCARE - CAMP HILL 6/1/2005 6/30/2005
O/C ORDER DATE ORDER CODE TIME ORDER TEXT DESC_ TEXT
8/15/2001 vitam. QD MULTIPLE VITAMINS W/MlNERALS-GENERIC
TABS (MULTIPLE VITAMINS-MINERALS) 1 TAB
Oral daily for 269.9 Other
nutritional deficiencies, unspecified
nutritional deficiency 99999-1002-
1/31/1995 Lab Q12M U/A-CBC YEARLY JAN
6/14/1997 Lab Q3Mo AMA COMPREHENSIVE PANEL Q 3 MONTHS
FEB/MAY/AUG/NOV
1217/1999 Rt_Tx ENCOURAGE FLUIDS Q SHIFT
2/1/2001 Rt_Tx QWK Weekly body skin assessment once each
week
5/8/1998 Nur_Re NURSING REHAB ADL PROGRAM DAILY
2/16/2005 Nur_Re NSG.REHAB AMBULATION PROGRAM DAILY
P1an:participate 15 minslday
7/13/2001 Nsg_O APPLY HOUSE LOTION TO SKIN EVERY SHIFT
5/28/2003 Nsg_O Shower residents 2 Xlweek,Water temps
to be recorded prior to performing task
11/24/2003 Nsg_O BID APPLY CORN STARCH PWD UNDER BlLAT
BREAST AFTER CLEANSING WI SOAP &: H2O
Topical two times per day
3/18/2005 NSILO SHIF Protective Barrier Cream cleanse
perianal, buttock region then apply crm
to sites after each incontinence
episode and or Q Shift every shift
1/31/1995 Meds PRN DULCOLAX 10 MG PR QD PRN IF MOM
INEFFECTIVE (BISACODYL)
*********** *******'" ***** *****************************************
*********** ******** ***** *****************************************
* I have reviewed &: ap rove all orders: ~ *
* Physic an Signa ture: Date: 6/1<(*/11(' -
* LicenSE d Nurse Signa ure: Date: *
*********** ******** ***** *****************************************
NURSING ALERT:
PHYSICIAN 1 PHONE NO. I ALTERNATE PHYSICIAN I PHONE NO.
~- ... 1'7''7_'7'" _"...., 1 1'7''7..'7'" _"....,
DIAGNOSES ALLERGIES
436. CVA (Cerebrovascular Accident) -- 294.8 MEMBUTAL
ORGANIC BRAIN SYND NEC -- 443.9 PERIPH VASCULAR
DIS NOS -- 593.9 RENAL &: URETERAL DIS NOS
682.6 CELLULITIS OF LEG
NAME I RECORD NO. I LOCATION BIRTHDA TE 1 AGE 1 ADMIT DATE I PAGE
Tretter Genevieve E 90959 12-00113-A 11/27/190'71 97 11/31/1995 T4
PHYSICIAN ORDERS
POFORM
INRE:
ORPHANS' COURT DIVISION
GENEVIEVE TRETTER,
No. ~ \ ~ 0 b - l q
AN ALLEGED INCAPACITATED
PERSON.
PETITION FOR THE APPOINTMENT
OF A PERMANENT PLENARY GUARDIAN
OF THE PERSON AND ESTATE
Cl
(")
N
U-.
C":,t(/':
UJ -,
c..:>
u:. -
\.C-
o
o
U.J
0_
0:: ',-<
ace'
<-)U_j
LUc...::::..
n:
C._
Filed on Behalf of Petitioner:
z:
"-
l'..
8
y:
u~
LL!
---I
u~ .
e,__.
c.::::-
0"
U
Beverly HeaIthcare Camp Hill
Our Matter No. 121-05
<."
:=>
..u::
'-'"
c:::)
=
c.....
TO THE PROTHONOTARY;
PRAECIPE TO SUBSTITUTE SIGNATURE PAGE
Please substitute the following signature page into the Petition for Appointm
P/erm6an~rn'PI'_G_;~::~:.w E"'''"f~~~::,Av
By:
Mich I B. Volk, Esquire
Attorney LD. # 88553
2933 North Front Street
Harrisburg, PA 17110
(717) 233-4101
Attorney for Plaintiff
01