Form CCP 0211 at a glance
What it is: Report of Physician: a licensed physician submits a Report on an alleged person with a disability.
Who signs: This Report must be signed by a licensed physician.
A filled-in Form CCP 0211 example: a physician reports on an alleged person with a disability
How to fill out Form CCP 0211, box by box
Case number, calendar and estate
Fill in Case No., Calendar and Estate of.
The physician, the Respondent and the evaluation date
The evaluations upon which this Report is based must have been performed within three (3) months of the date the Petition for guardianship is filed.
Enter the printed name of the physician.
Enter the printed name of the alleged person with a disability, the Respondent, and fill in the line after "performed on" for the evaluations of the Respondent.
1. Description of the disability
In box 1, describe the nature and type of the Respondent's disability and an assessment of how the disability impacts on the ability of the Respondent to make decisions or to function independently, including an underlying diagnosis and a description of the manifestations of the disability.
2. Analysis and results of evaluations
In box 2, enter an analysis and the results of evaluations of the Respondent's mental and physical condition, and (if appropriate) a description of the Respondent's educational condition, adaptive behavior and social skills.
3. Opinion on guardianship
In box 3, enter your opinion as to whether guardianship is needed, the type and scope of the guardianship needed, and the reasons for your opinion, including whether the Respondent is totally or only partially incapable of making personal and financial decisions and if only partially, the kinds of decisions which the Respondent can and cannot make.
4. Living arrangement and treatment plan
In box 4, enter your recommendation as to the most suitable living arrangement for the Respondent and (if appropriate) the treatment or habilitation plan for the Respondent, and the reasons for your recommendation.
5. Other professionals who evaluated the Respondent
If the description of the Respondent's mental, physical and educational condition, adaptive behavior or social skills is based upon evaluations by other professionals, all professionals preparing evaluations must also sign this Report.
In box 5, list the names, addresses, certifications, licenses or other credentials, and signatures of each other person who performed an evaluation upon which this Report is based.
For each of a and b, fill in Name, Address, License (state and number), Certification, Other Credentials and Signature.
Licensed physician preparing this report
The licensed physician preparing this report fills in Signature, License (state and number), Address, City/State/Zip, Phone, Certification and Other Credentials.
Sources
[1] Form CCP 0211 (05/14/25), Report of Physician, Clerk of the Circuit Court of Cook County, Illinois (the Official source link on this page).