THE COURTS
DAUPHIN COUNTY
New Rules of the Orphans' Court Division; AO-31-2007; No. 1793 CV 1989; No. 1-1991
[38 Pa.B. 223]
[Saturday, January 12, 2008]
Order And Now, this 18th day of December, 2007, Dauphin County Local Orphans' Court Rule 14.2 is amended as follows:
* * * * * (c) Evidence in support of a Petition seeking determination of incapacity shall be presented at the hearing pursuant to the Probate, Estate and Fiduciary Code at 20 Pa.C.S. § 5518. In non-contested matters, in lieu of the presentation of testimony in person or by oral deposition, a written ''Deposition of Individual Qualified to Render Opinion as to Incapacitation'' may be prepared and filed in the office of the Clerk of the Orphans' Court prior to the hearing. An ''Individual Qualified to Render Opinion as to Incapacitation'' pursuant to this Rule shall be a licensed psychologist, psychiatrist or medical doctor. Said document shall be substantially in the form provided in Appendix A of the Local Orphans' Court Rules and shall be typed and verified. A form for completion is also available online at the Dauphin County website (www. dauphincounty.org).
These amendments shall be effective 30 days after publication in the Pennsylvania Bulletin.
By the Court
RICHARD A. LEWIS,
President Judge
APPENDIX A
IN THE COURT OF COMMON PLEAS OF DAUPHIN
COUNTY, PENNSYLVANIA ORPHANS'
COURT DIVISIONIN RE:
DEPOSITION OF INDIVIDUAL QUALIFIED TO RENDER OPINION AS TO INCAPACITATION This written deposition of ______ , a witness in this matter, is taken on the ____ day of ______ , at ______ , Pennsylvania.
1. Please state your name and your professional address.
2. Please describe your education, training and background with particular emphasis on your expertise in evaluation of individuals with incapacities OR attach to this written deposition your curriculum vitae.
3. In your professional capacity, have you had the opportunity to meet with, examine, speak with or otherwise become acquainted with ______ ?
(name of patient)If yes, please state the following:
I first became acquainted with ______ on (name of patient)
______ , when he/she was brought to my attention by _________________.I have since (visited, spoken with, examined or treated) (circle applicable contacts)
him/her on ______ other occasions with an average frequency of ____ times per ______ . (day/week/month/year)4. Please evaluate the present condition of this patient with respect to incapacities of the type alleged in the Petition for Adjudication of Incapacity.
In particular, please comment on the nature and extent of the alleged incapacities and disabilities and also, insofar as you are able, his/her mental, emotional and physical condition, adaptive behavior, and social skills.
Based upon my education, training and experience, as well as my acquaintance with this patient, it is my opinion, to a reasonable degree of medical certainty, that his/her incapacities are as follows:
Mental condition
__________
__________Emotional condition
__________
__________Physical condition
__________
__________Adaptive behavior
__________Social skills
__________5. Based upon your education, training and experience, and your contacts with this patient, do you have an opinion, to a reasonable degree of medical certainty, whether he/she is impaired in his/her ability to effectively receive and evaluate information and to make and communicate decisions in any way?
If yes, please explain your opinion.
6. If you are of the opinion that he/she is impaired in his/her ability to effectively receive and evaluate information and to make and communicate decisions in any way, does such impairment render him/her either partially or totally unable to manage his/her financial resources?
If yes, check whether such impairment renders him/her:
____ Partially unable to manage his/her own finances.
____ Totally unable to manage his/her own finances.
Please explain your opinion.
7. If you are of the opinion that he/she is impaired in his/her ability to effectively receive and evaluate information and make and communicate decisions in any way, does such impairment render him/her either partially or totally unable to meet the essential requirements for his/her physical health and safety?
If yes, check whether such impairment renders him/her:
____ Partially unable to meet essential requirements for his/her physical health and safety.
____ Totally unable to meet essential requirements for his/her physical health and safety.
Please explain your opinion.
8. Please provide an assessment of the severity of any impairments of this patient.
Impairment
(Circle one)
a) ______ mild moderate severe b) ______ mild moderate severe c) ______ mild moderate severe d) ______ mild moderate severe e) ______ mild moderate severe f) ______ mild moderate severe g) ______ mild moderate severe h) ______ mild moderate severe 9. Is the condition of this patient such that because of his/her condition, he/she would be susceptible to undue influence by unscrupulous or designing persons?
If so, what services or assistance would you recommend as necessary to appropriate management of this patient's finances?
10. What services or assistance would you recommend as necessary to meeting the health and safety needs of this patient?
11. Are the services or assistance recommended the least restrictive alternatives?
Does the patient need the services of the guardian to make decisions regarding the patient's healthcare, safety and financial resources? In other words, could the patient evaluate, communicate and make decisions regarding his/her health treatment, safety and financial resources in important matters without the guardian?
If not, please explain why less restrictive alternatives are inappropriate.
12. Based upon your education, training, experience and familiarity with this patient, what is your opinion as to the likelihood that the degree of incapacitation will significantly change?
13. Would the physical or mental condition of this patient be harmed by his/her presence in open court? NOTE: Pennsylvania law, 20 Pa.C.S. § 5511(a)(1), requires that the alleged incapacitated person be present at the hearing unless a physician or licensed psychologist provides by deposition, testimony or sworn statement, an opinion that his/her physical or mental condition would be harmed by his/her presence in court. If yes, please explain.
VERIFICATION I, ______ , verify that the statements made in the foregoing deposition are true and correct to the best of my knowledge, information and belief. I understand that the statements herein are subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities.
_________________
Signature of Deponent
Dated: ______
[Pa.B. Doc. No. 08-41. Filed for public inspection January 11, 2008, 9:00 a.m.]
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