Bexar County, TX · Bexar County
Health Care Provider’s Certificate of Medical Examination
This certificate lets a physician, psychologist, or advanced practice registered nurse report an alleged incapacitated person’s medical condition and ability to make decisions to the court.
At a glance
- Issued by
- City of Bexar County · Bexar County, Bexar County, Texas
- Notarization
- Not required: file this form without a notary.
- Official source
- bexar.org
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
A physician, psychologist, or advanced practice registered nurse completes this certificate to help the court determine whether an individual is incapacitated and whether a guardian should be appointed. It asks about the provider’s qualifications, the individual’s diagnoses, cognitive abilities, decision-making, capacity, ability to attend a hearing, and appropriate placement. The form also includes instructions for specific intellectual-disability determinations.
Who needs it
A physician, psychologist, or advanced practice registered nurse examining an alleged incapacitated person for a guardianship matter completes this certificate for the court.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details.
About notarization
This certificate has signature and date lines but no notary block; the health care provider and, when applicable, supervising physician sign and date it.
How to submit this form
- 1
Download the Certificate
Download the Health Care Provider’s Certificate of Medical Examination PDF.
- 2
Complete the Evaluation
The examining provider completes the relevant sections about qualifications, examination findings, capacity, and the proposed ward.
- 3
Gather Any Attachments
Attach a copy of the mini-mental status exam if one was given. Use an additional page for other information the court should know.
- 4
Sign and Submit
The provider signs and dates the certificate; a supervising physician also signs and dates it when the examination was conducted by an advanced practice registered nurse. Submit it to the county department named on the form.
Frequently asked questions
- Who completes the Health Care Provider’s Certificate of Medical Examination?
- A physician, psychologist, or advanced practice registered nurse completes the certificate to provide the court with information about the proposed ward’s condition and capacity.
- What information does the certificate ask for?
- It asks about the provider’s qualifications and examination, the proposed ward’s physical and mental functioning, decision-making abilities, capacity, hearing participation, and appropriate placement.
- Do I need a notary for the Health Care Provider’s Certificate of Medical Examination?
- No. The certificate has signature and date lines but no notary block; the health care provider and, when applicable, supervising physician sign and date it.
- How do I submit the certificate?
- The document does not give submission instructions. Submit it to the county department named on the form; check the county website for current contact details.