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THE COURTS

NORTHAMPTON COUNTY

Presentation of Expert Testimony by Written Deposition to Support a Finding of Incapacity in Guardianship Hearings; Administrative Order 2016-01

[46 Pa.B. 6826]
[Saturday, October 29, 2016]

Order of Court

And Now, this 21st day of July, 2016, it is hereby Ordered and Decreed that in order for this Court to accept expert testimony by written deposition pursuant to 20 Pa.C.S § 5518, the following conditions must be met:

 1. The individual providing such expert testimony must be licensed to practice medicine, osteopathy, or psychiatry in Pennsylvania, or be otherwise qualified by training and experience in evaluating persons with the type of incapacity as alleged by the Petitioner.

 2. The requested information must be provided on the following form and must be complete and clearly legible.

 3. The answers must be signed and verified subject to the penalties of 18 Pa.C.S. § 4909 (relating to unsworn falsification to authorities) by the individuals providing such testimony.

 4. At the hearing, the Petitioner shall present the Court either (1) the completed written deposition, with verification bearing the expert witness' original signature, or (2) a time-stamped copy of the written deposition and verification demonstrating that the original has been filed with the Clerk of Orphans' Court.

 5. Expert testimony by written deposition will be accepted only when the issue of incapacity is uncontested. When the alleged incapacity is in dispute, expert testimony must be provided via live testimony or telephone testimony.

 Counsel for Petitioners and pro se Petitioners are responsible for compliance with these instructions. The failure to comply with the foregoing may result in the rejection of proffered expert testimony by written deposition, at the Court's discretion.

By the Court

EMIL GIORDANO, 
Judge

IN THE COURT OF COMMON PLEAS OF NORTHAMPTON COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION

IN RE: ______ ) No.
  AN ALLEGED )
  INCAPACITATED PERSON )

WRITTEN DEPOSITION OF PHYSICIAN OR LICENSED PSYCHOLOGIST PURSUANT TO 20 Pa.C.S. § 5518

 Physician or Licensed Psychologist (Name): __________

 Office address: __________

 Current position: __________

 PROFESSIONAL BACKGROUND (In lieu of providing responses to questions 1-6, you may attach your curriculum vitae. Please provide any requested information not addressed in the curriculum vitae.)

 1. Provide the following information concerning your education:

Name of Institution Degree received Date of Graduation
Undergraduate
Graduate
Post-Graduate

 2. List all of your active professional licenses, the state/name of the issuing agency, and any board certifications, along with the dates each was issued/awarded.

 3. Do you have experience in evaluating individuals to determine their mental capacity?

 Yes ____  No ____

 4. If your answer to the above question is ''Yes'', please indicate the basis of your experience and describe your specialized qualifications and training with respect to evaluating persons to determine their mental capacity.

 5. Have you ever testified in court or in an administrative proceeding, or have you provided testimony by deposition or by written interrogatories regarding an individual's mental capacity, prior to today?

 Yes ____  No ____

 6. If your answer to the above question is ''Yes'', please provide an estimate of the number of times you provided testimony by deposition or by written interrogatories regarding an individual's mental capacity, prior to today:  _________________

INFORMATION CONCERNING THE ALLEGED INCAPACITATED PERSON

 7. In your professional capacity, have you had the opportunity to meet with, examine, evaluate or assess the alleged incapacitated person?

 Yes ____  No ____

 If your answer to the above question is ''Yes'', provide the dates within the past two (2) years that you have met with, examined, evaluated or assessed the alleged incapacitated person:

 8. Identify any tests that were administered to evaluate/assess the alleged incapacitated person's mental capacity (e.g. mini mental status exam—MMSE), along with the date of each tests and the results/conclusions drawn from each test:

Date Test Results/Conclusions

 9. Identify all medical and psychiatric diagnoses that you believe impact the alleged incapacitated person's mental capacity, along with the symptoms/manifestations of each diagnosis, and the prognosis for each:

Diagnosis Symptoms/Manifestations Prognosis

 10. List all other current medical diagnoses/conditions of the alleged incapacitated person of which you are aware:

 11. List all medications presently prescribed for the alleged incapacitated person, and the diagnosis for which each medication was prescribed:

Medication Diagnosis

 12. Indicate the alleged incapacitated person's abilities with respect to the following activities of daily living by placing an ''X'' in the appropriate space below:


No Impairment Needs Some Help Totally Impaired Insufficient Information
Eating
Bathing
Dressing
Toileting
Transferring
Preparing meals
Basic housework
Personal hygiene
Managing medication
Complying with medical treatment

 13. Indicate the alleged incapacitated person's abilities with respect to the following activities by placing an ''X'' in the appropriate space below. Additional information will be requested for all items/activities marked ''needs some help''.

No Impairment Needs Some Help Totally Impaired Insufficient Information
Understanding medical conditions and any physical limitations
Making appropriate living arrangements
Managing finances/paying bills
Applying for financial or medical benefits
Avoiding financial exploitation
Communicating decisions
Receiving and evaluating information
Short term memory
Long term memory
Responding to emergency situations
Providing for his/her physical safety

 14. For all items/activities in the above chart (Interrogatory 13) in which you indicate that the alleged incapacitated person ''needs some help'', provide details as to the type and extent of assistance needed.

 15. List any services that, to your knowledge, are being provided to meet essential requirements for the health and safety of the alleged incapacitated person, or to assist the alleged incapacitated person with management of his/her finances.

 16. What, if any, recommendations do you have concerning services necessary to meet essential requirements for the health and safety of the alleged incapacitated person?

 17. What, if any, recommendations do you have concerning services necessary to assist the alleged incapacitated person with management of his/her finances?

 18. Do you believe that the alleged incapacitated person is capable of making reasonable decisions regarding his/her personal care, medical care, and safety?

 Yes ____  No ____

 19. Do you believe that the alleged incapacitated person is capable of making reasonable decisions regarding his/her finances?

 Yes ____  No ____

 20. In your professional opinion, is the person who is the subject of this hearing incapacitated?

 Yes—totally impaired ______ Yes—partially impaired ______ No ____

 21. Do you expect the alleged incapacitated person's mental condition to significantly change or improve?

 Yes ____  No ____

 Please provide a basis for your answer:

 22. Would any less restrictive alternatives to the appointment of a plenary guardian be sufficient to protect the alleged incapacitated person from physical and financial harm?

 Yes ____  No ____

 If your answer to the above question is ''No'', explain why less restrictive alternatives would be insufficient to protect the alleged incapacitated person from physical and financial harm?

 23. Do you believe that it would be harmful to the alleged incapacitated person's physical or mental condition if he/she was to be present in court for the hearing in this matter?

 Yes ____  No ____

 24. Are you able to provide any additional information that would assist the Court in determining the alleged incapacitated person's need for a guardian and/or person(s) who would/would not be appropriate guardians?

 25. Are your answers to all of the above questions provided within a reasonable degree of medical certainty?

 Yes ____  No ____

VERIFICATION

 I verify that the foregoing information is true and correct to the best of my knowledge, information and belief. I am aware that this verification is subject to the penalties of 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities.

______   _________________
Date         Signature

_________________
Name (type or print)

_________________
Address

_________________
City, State, Zip Code

_________________
Phone

[Pa.B. Doc. No. 16-1856. Filed for public inspection October 28, 2016, 9:00 a.m.]



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