Form Cj P 103 PDF Details

In the realm of legal and medical intersections within Massachusetts, the Cj P 103 form serves as a crucial document, primarily used in the domain of conservatorship cases adjudicated by the Probate and Family Court. This specialized form, requiring meticulous completion by a registered physician, is pivotal for cases where a person’s capacity to manage their property is in question due to mental or physical incapacities. Physicians are tasked with certifying, under the penalties of perjury, their professional opinion on the examined individual's (proposed ward’s) condition, detailing their inability to oversee their property effectively. The form captures the essence of this assessment, providing clear categories for mental weakness or physical incapacity, while also mandating the proposed ward's assent in scenarios involving solely physical incapacity, as dictated by state law G.L.M. c. 201 §16. Beyond this, it delves into the necessity for a detailed diagnostic explanation that led to the physician's conclusion, shedding light on the types of decisions the proposed ward can comprehend and make. Integral to the conservatorship process, the Cj P 103 form thus embodies a critical step in safeguarding the interests of individuals who may not be fully capable of managing their affairs, ensuring a thorough and professional evaluation is in place to guide the court’s judgment.

QuestionAnswer
Form NameForm Cj P 103
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesmedical certificate filled form, how to fill up medical certificate form for students, medical certificate filled, medical certificate fill

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Commonwealth of Massachusetts

 

The Trial Court

 

Hampshire Division

Probate and Family Court Department

Docket No.

MEDICAL CERTIFICATE - CONSERVATORSHIP

To the Honorable Justices of the Probate and Family Court:

The undersigned hereby certifies under the penalties of perjury that I am a registered physician and that I personally examined

(name of proposed ward)

(street address)

(city or town)

(state)

on

(date of examination)

and in my opinion the proposed ward:

is unable to properly care for his/her property due to mental weakness.

is incapable of caring for his/her property due to a physical incapacity. When seeking a conservatorship of a person with a physical incapacity ONLY the ward must assent to the petition. See. G.L.M. c. 201 § 16 and the physician must make the following certification.

I further certify that the proposed ward has sufficient mental ability to comprehend the nature of his/her act in assenting to the petition.

THIS SECTION MUST BE COMPLETED FOR A CONSERVATORSHIP PETITION WITHOUT ASSENT:

Describe in detail the diagnosis leading to the aforementioned opinion (including the types of decisions which the proposed ward has sufficient mental ability to make):

(OVER)

CJ-P 103 (10193)

hcpfc - c.g.f.

(MEDICAL CERTIFICATE - CONSERVATORSHIP BACK)

Date

(signature)

(PRINT name)

(address, including zip code)

Tel. No. (

)

Uniform Probate Court Practice XXII.

A physician's certificate, when accepted, must be dated and the examination must have taken place within thirty (30) days prior to the entry of each decree, temporary or permanent.

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