IN THE SUPREME COURT OF BRITISH COLUMBIA IN THE :YIATTER OF THE PATIENTS PROPERTY ACT R.S.B.C. 1996, CHAPTER 349 AS AMENDED -AND-

Similar documents
Notice to The Individual Signing The Power of Attorney for Health Care

Planning for the Future: The Role of Advance Directives

Advance Health Care Directive Form Instructions

MENTAL HEALTH ADVANCE DIRECTIVES

A PRACTICAL GUIDE FOR ADVANCE CARE PLANNING

A PRACTICAL GUIDE FOR ADVANCE CARE PLANNING

LASTING POWERS OF ATTORNEY

Health Care Proxy. Appointing Your Health Care Agent in New York State

4. Your agent will start making decisions for you when doctors decide that you are not able to make health care decisions for yourself.

(Protectorate) Registration Ordinance; it shall apply to the Protectorate.

COMBINED. Mental Health Declaration and Power of Attorney

Enforcement Regulations of the Pharmaceutical Affairs Law

CENTRAL VIRGINIA LEGAL AID SOCIETY, INC.

LAWS OF PITCAIRN, HENDERSON, DUCIE AND OENO ISLANDS. Revised Edition 2014 CHAPTER XIX BIRTHS AND DEATHS REGISTRATION ORDINANCE

NOTICE TO THE INDIVIDUAL SIGNING THE POWER OF ATTORNEY FOR HEALTH CARE

ADVANCE DIRECTIVES. Planning Ahead: How to Make Future Healthcare Decisions NOW

BEFORE THE OIL AND GAS CONSERVATION COMMISSION OF THE STATE OF COLORADO ) ) ) ) ) ) ) ) ) ) ) ) ) ) AMENDED APPLICATION

BEFORE THE OIL & GAS CONSERVATION COMMISSION OF THE STATE OF COLORADO DOCKET NO: APPLICATION

Utah Advance Directive Form & Instructions

ONTARIO SUPERIOR COURT OF JUSTICE COMMERCIAL LIST

Being 'Sectioned' The Mental Health Act 1983

BEFORE THE OIL AND GAS CONSERVATION COMMISSION OF THE STATE OF COLORADO ) ) ) ) ) ) ) ) ) ) ) ) ) ) AMENDED APPLICATION

New York Health Care Proxy / Advance Directive for Mental Health Treatment of

DETERMINATION OF POPULATION REGULATION

INSTRUCTIONS FOR COMPLETING THE CALIFORNIA ADVANCE HEALTH CARE DIRECTIVE LEGAL FORM

Writing Your Mental Health Advance Directive. A Practical Guide

Here s how to complete a Health Care Proxy:

Herefordshire CCG Patient Choice and Resource Allocation Policy

Enduring Power of Attorney

DETERMINATION OF POPULATION REGULATION

Advance Care Planning: Goals of Care Team

MULTIPLE ENTRY CONSOLIDATED GROUP TSA USER AGREEMENT

Being able to make choices about your life and your care changing the law to do with mental capacity

BEFORE THE OIL AND GAS CONSERVATION COMMISSION OF THE STATE OF COLORADO ) ) ) ) ) ) ) ) ) APPLICATION

Carriage Park Center

WILTON MANORS, Island City 2020 WILTON DRIVE, WILTON MANORS, FLORIDA 33305

How to Choose a Health Care Agent

PATENT AND LICENSING POLICY SUMMARY

Diana Gordick, Ph.D. 150 E Ponce de Leon, Suite 350 Decatur, GA Health Insurance Portability and Accountability Act (HIPAA)

About Advance Directives for Mental Health

IN THE CIRCUIT COURT OF THE SEVENTEENTH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA

Patient Choice and Resource Allocation Policy. NHS South Warwickshire Clinical Commissioning Group (the CCG)

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Patient Information Leaflet

Financial Services Tribunal Annual Report

Eligibility: Who may apply. Who can apply for Spanish citizenship as a result of the Citizenship Law for Sephardi Jews?

BEFORE THE OIL AND GAS CONSERVATION COMMISSION OF THE STATE OF COLORADO APPLICATION

Giving another person access to your GP online services. Patient Guide

J. HENRY SCHRODER BANK & TRUST COMPANY N/K/A IBJ SCHRODER BANK & TRUST COMPANY TAT (E) (CR) - ORDER

SUPERIOR COURT OF THE DISTRICT OF COLUMBIA ORDER

Notice of Privacy Practices

KRYPTONITE AUTHORIZED ONLINE SELLER APPLICATION AND AGREEMENT Effective: January 1, 2018

City of Saratoga Springs Vital Records

Conversation Guide. Hospice of Southwest Ohio and CareBridge are dedicated to helping people talk about their wishes for end-of-life care.

Getting Started Tool Kit

APPLICATION TO AMEND CERTIFICATE OF BIRTH

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO

Approach A Solution-Oriented Perspective

Advance Care Planning Conversations:

Guidelines for Completion of a Youth Application

ONTARIO SUPERIOR COURT OF JUSTICE

POA-Power of Attorney for Personal Care

CASS COUNTY CLERK CASS COUNTY COURTHOUSE P. O. BOX E HOUSTON ST LINDEN, TX FAX

New York Bar admission (or eligibility to obtain admission promptly) is required.

isns Health Care Treatment and Consent

Consent. Making decisions about your health care and treatment NHS SCOTLAND

TENNESSEE DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES, Petitioner, vs. GWENDOLYN STEWART-JEFFERY, Grievant

[Investment Company Act Release No ; ] New Mountain Finance Corporation, et al.; Notice of Application

IAC/INTERACTIVECORP Filed by GOLDMAN SACHS ASSET MANAGEMENT LP

Case 2:11-cv BSJ Document 2203 Filed 11/20/14 Page 1 of 5

Advance Care Planning. It s time to speak up!

IN THE MAORI LAND COURT OF NEW ZEALAND TAITOKERAU DISTRICT 9 TAITOKERAU MB 209 (9 TTK 209) A A

IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT IN AND FOR MIAMI-DADE COUNTY, FLORIDA AFFIDAVIT IN SUPPORT OF ARREST WARRANT

Christina Narensky, Psy.D.

Welcome to Althea. Welcome to the future of integrated healthcare technology management

Guide to getting a Lasting Power of Attorney

When somebody dies suddenly. A guide to coronial services in New Zealand

Getting Started Tool Kit

scc Doc 210 Filed 05/06/18 Entered 05/06/18 22:38:17 Main Document Pg 1 of 173

(131st General Assembly) (Amended Substitute Senate Bill Number 61) AN ACT

Your Conversation Starter Kit

Mrs. Mary Abel (Dr. Herman Abel)

Choices. Directions for patients and family members about medical decision making

WHEN SOMEONE DIES SUDDENLY. A guide to coronial services in New Zealand

The Role of Patients in Transitions of Care

Medical Record Access Information for Applicants

Transition Planning: A Guidebook for Young Adults and Family

THE LAW SOCIETY OF ALBERTA HEARING COMMITTEE REPORT

Action: Notice of an application for an order under sections 6(c), 12(d)(1)(J), and 57(c) of the

The Malkin Group at Morgan Stanley

LAW ON RECORDS OF BIRTHS, DEATHS AND MARRIAGES

INQUESTS -A FACTSHEET FOR FAMILIES

FILED: NEW YORK COUNTY CLERK 10/11/2010 INDEX NO /2010 NYSCEF DOC. NO. 24 RECEIVED NYSCEF: 10/11/2010

Appointment of an agent form

Harp Dhillon Group Private Wealth Managers of RBC Dominion Securities

Care Co-ordination and Care Programme Approach CPA. Help and support for people with mental health problems - an easy read guide

Registration of Births Deaths and Marriages (Amendment) Act 1985

FILED: NEW YORK COUNTY CLERK 05/14/ :29 PM INDEX NO /2017 NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 05/14/2018

SAN DIEGO CITY SCHOOLS

NYC Birth Certificate Correction Checklist

CHAPTER 2. BIRTH CERTIFICATES

Transcription:

JAN Z J 2008 J. Jordan #1 Sworn January 16, 2008 IN THE SUPREME COURT OF BRITISH COLUMBIA IN THE :YIATTER OF THE PATIENTS PROPERTY ACT R.S.B.C. 1996, CHAPTER 349 AS AMENDED NO. 073415 VICTORIA REGISTRY -AND- IN THE MA TIER OF KATHLEEN PALAMAREK, PATIENT AFFIDAVIT I, JOHN E. JORDAN, Barrister and Solicitor, of704-880 Douglas Street, Victoria, British Columbia, MAKE OATH AND SAY THAT: 1. I am a member in good standing of the Law Society of British Columbia. I have personal knowledge of the facts and matters hereinafter deposed to except where expressly stated to be on infonnation and belief and where so stated I verily believe them to be true. 2. I am an associate lawyer at Straith & Company in Victoria. I was called to the bar in 1989. I was fonnerly an associate lawyer at Stevenson Luchies & Legh ("SSL" in Victoria. I practice as a solicitor in the areas of estate and trust planning and wealth preservation. 3. In JUly, 2007, while still working at SSL, Ms. Lois Sampson approached me in relation to her mother Kathleen Palamarek. At that time, I had no knowledge of any Petition relating to committeeship. Nor, to my knowledge, did Ms. Sampson, who to my knowledge was not served with the Petition until some time later. 4. Ms. Sampson advised me that Mrs. Palamarek was Jiving in the extended care ward at

-2- Saanich Peninsula Hospital and had been there for some time. Ms. Sampson expressed her concern to me that she felt this was not an appropriate facility for her mother. She also expressed concern to me that her mother might have been on medications that may have been exacerbating her mother's condition. 5. Ms. Sampson further advised me that one or more of her brothers was in control of her mother's finances and assets. She told me that one brother was living in!virs. Palamarek's home and she did not know if he was paying rent or if some other arrangement was in place. She expressed concern that her brothers, who J understood were attorneys under a Power of Attorney, had not provided her with any information about their mother's fmances and their management of those fmances. 6. Ms. Sampson further advised me that she felt her mother's condition and finances should permit her to live in more comfurtable surroundings than the extended care ward at Saanich Peninsula Hospital. To obtain further information in this regard, Ms. Sampson wanted to access her mother's medical and financial records. She advised that she did not feel her brothers would voluntarily provide these records to her. 7. Ms. Sampson advised me that she had discussed these issues with her mother and that her mother said she wanted to give Lois access to her medical records and access to her t1nancial records. Lois advised me, however, that she wanted her mother to speak to a lawyer about this first and that if I felt satisfied I could take instructions from /virs. Palamarek that I should prepare consent forms for Mrs. Palamarek to sign if she so wished. 8. I mel "'ith Mrs. Palamarek several times during July and August, 2007. Ultimately, J was satistied that she understood the issue of consenting to the release of her medical and financial information to her daughter, and I was satistied she was able to give me this instruction. Accordingly, I drafted two consent forms and witnessed Mrs. Palamarek signing them. The two consent forms are attached hereto and marked as Exhibit "A" to this Affidavit.

-3-9, I do not represent any party in connection with the Petition, and have no ongoing involvement in this case, I understand that John Campbell of Straith and Company filed an Appearance for Ms, Sampson in relation to the Petition, Mr, Campbell is no longer involved in the case, SWOR.>.J BEFORE ME at Victoria, British Colwnbia on this 16th day of January, 2008, A Commissioner for t ing Affidavits for British Col Commissioner's Name and/or Seal: KAREN HENRY STRAITH & COMPANY BARJUSTER & SOLlClTOR 704-880 DOUGLAS STREET ViGt9Fia Be va'/!;' 213r

TO MY HEALTHCARE PROVIDERS: RE; KATHLEEN PALAMAREK I KATHLEEN PALA.\1AREK, cull'l:11.tly (fthe Saanich Peninsula Hospital, 2166Mt. Newton X Road, Saanlchton. British Columbia, VSM 2B2, being of sound and disposing mind, h<lreby DlRECf thai any healthca:n: giver ofrnlne, including any physician&, psychologist, psychiatrist, including geriatric psychiatrists, healtbcare worker, nurse or social worlrer shall pr{vide to my daughter LOIS SAMPSON an' and all <lltisting medical information, including any repom resp<lcting my physical and mental health. o"r>- Dated this._,_ day of August, 2007, leo.volrdan Barrister & Solicitor. St"""llSon Lw:hle. & LcgiJ ~ult. 300-843 Courifle, 51 Victoria Be V8W 1 C4 7hls Is Exhibit A refi1rrep In the afflcjlnitof. -:701-1/\/ t. J<J"eC>~N : ~wom be;;re me, at~~r..~.iid~. C. P this",,;,:(ij:!:aay o;li~v..d;f3:y20"-';l8 "'''~-.. ~~..."... "... A COMMISSIONER FOR AKING AFFIDAVlTS FOR BRITIS COLUMBIA

TO WHOM IT MAY CONCERN: RE: FfNANC14L AFFAIRS OF KATHLEEN PAUM1Rfi:K I KATHLEEN PALAMAREK, c=t1y of the Saanich Peninsula Hospital, 2166 Mt. Newton X Road, Saanichlon, British Colwnbia, VaM 182, being of sound and disposing mind, hereby DIRECT tbat my daughter LOIS SAMPSON, shall be given full and complete financial disclosure of all my _Is, income. income tax. information. including all my banking afiiliis by (1 any person or entity having knowledge or records of my finances, and by (2 my son, RALPH P ALAMAREK and my sonernestpalamarek wboare theagentslhsve appointed unrlerageneralpowerof Attorney. I also DIRECT my said agents named Ullder the said Power of Attorney. namely, my sen, RALPH PALAMAREK and my son ERNEST P ALAMAREK or any other person or entity hsving a tt1.le copy of such Power of Attorney to provide my daughter, LOIS SAMPSON with a tt1.le copy of the aforesaid Power of Attooley thali have granted 10 my son, RALPH P ALAMAREK and my SOn ERNEST PALAMAREK.. Yours tttily, Daled this _'3 '7\daY. of August. 2007 E. JORDAN JJarriJ:/ey &: Solicir(r Ste'JeDSOn Locbi '" Legh ~te 300-848 Courtney S, Vkltoria llc V8W! C4