Date
of Last Review 3/28/07
SME: Director of Social Services
When completed:
The Attending Physician completes the
Certificate of
Medical Exam with OPC - Extended
for a patient in the following situations:
 | Whose condition is expected to continue for more than 90 days |
| Who has had at least 60 consecutive days of court-ordered services within the last 12 months |
Copies of form:
Staff sends the original completed form to the court via the HCPI/MHMRA Court Liaison and places the last copy in the patient's medical record.
When completed:
The treatment team evaluates the patient's competency and support systems. If s/he is evaluated as incompetent to make decisions, attempts are made to locate family that will file for guardianship. If unavailable, the attending physician writes a Doctor's Mental Status Exam for Guardianship letter to the Probate Court including the following:
| Diagnosis |
| Condition of the patient |
| Reason guardianship is requested |
| Names of next of kin |
Guardianship recommendations:
Recommendations for full guardianship should be requested if it is the least restrictive possible because a full guardianship takes away all of an individual's rights
Recommendations for limited guardianship should specify just those areas where the patient is considered incompetent, such as financial matters.
Copies of form:
Staff sends the original completed form to the court via the HCPI/MHMRA Court Liaison and places the last copy in the patient's medical record.
Status notification:
The HCPI/MHMRA Court Liaison notifies the treatment team of the status of the request.
Related to regulatory standards
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