El Paso County, TX · El Paso County
Health Care Provider’s Certificate of Medical Examination
This certificate records a proposed ward’s medical examination and evaluation for a physician, psychologist, or advanced practice registered nurse in a guardianship matter.
At a glance
- Issued by
- City of El Paso County · El Paso County, El Paso County, Texas
- Notarization
- Not required: file this form without a notary.
- Official source
- epcountytx.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The certificate helps the Court determine whether a proposed ward is incapacitated and whether a guardian should be appointed. It asks the examining provider for identifying and examination information, physical and mental health evaluations, cognitive and decision-making assessments, and opinions about court participation and appropriate placement. A provider completes the relevant sections, signs and dates the certificate, and attaches a mini-mental status exam copy if one was given.
Who needs it
A physician, psychologist, or advanced practice registered nurse examining a proposed ward for a guardianship matter completes this certificate for the Court.
How to submit it
Submit it to the county office named on the form; check the county website for current contact details.
About notarization
This certificate is signed and dated without a notary; if a mini-mental status exam was given, the provider attaches a copy, and no sworn or notarized attachment is specified.
How to submit this form
- 1
Download the Certificate
Download the four-page Health Care Provider’s Certificate of Medical Examination.
- 2
Complete the Relevant Sections
The examining provider completes the applicable examination, evaluation, and capacity sections.
- 3
Gather Any Attachment
If a mini-mental status exam was given, attach a copy.
- 4
Sign and Submit
The provider signs and dates the certificate, then submits it to the county office named on the form.
Frequently asked questions
- Who completes the medical examination certificate?
- The form is addressed to a physician, psychologist, or advanced practice registered nurse examining a proposed ward for a guardianship matter.
- What information does the certificate ask for?
- It requests examination details, physical and mental health evaluations, cognitive and decision-making assessments, and the provider’s opinions about capacity, court participation, and placement.
- Do I need a notary for the medical examination certificate?
- No. The provider signs and dates the certificate without a notary. If a mini-mental status exam was given, the provider attaches a copy.
- How do I submit the medical examination certificate?
- The form does not specify submission instructions. Submit it to the county office named on the form, and check the county website for current contact details.