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Texas Guardianship Forms: Certificate of Medical Examination and Court Requirements

Index​

Introduction: Texas Guardianship Framework​

Texas guardianship law operates under a comprehensive statutory structure designed to protect incapacitated persons while preserving their autonomy to the maximum extent possible. The Texas Estates Code governs the creation, administration, and termination of guardianships throughout the state, reflecting a fundamental policy principle: guardianships are a last resort remedy, to be appointed "only as necessary to promote and protect the well-being of the incapacitated person".

Statutory Structure​

The Texas Estates Code defines an incapacitated person as "an adult who, because of a physical or mental condition, is substantially unable to provide food, clothing, or shelter for himself or herself; care for the person's own physical health; or manage the person's own financial affairs". This definition emphasizes functional limitations rather than medical diagnoses, requiring courts to assess whether individuals can perform specific life tasks with or without available supports and services.

The statutory framework mandates that courts design guardianships to encourage the development or maintenance of maximum self-reliance and independence in the incapacitated person. Texas law explicitly requires courts to consider less restrictive alternatives before appointing a guardian, including supported decision-making agreements, powers of attorney, healthcare directives, and other mechanisms that preserve individual autonomy while providing necessary assistance.

Person vs. Estate Guardianship​

Texas law recognizes distinct guardianship types addressing different aspects of an incapacitated person's needs.

Guardian of the Person: Controls the ward's personal matters, including decisions about housing, medical and dental treatment, psychological and psychiatric care, educational placement, and daily living arrangements. These guardians focus on the ward's physical well-being and quality of life rather than financial matters.

Guardian of the Estate: Manages the ward's property and finances, possessing authority to collect debts and claims, manage investments, sell assets with court approval, pay taxes and expenses, and handle all financial transactions on the ward's behalf. Guardian of the estate appointments receive heightened court scrutiny due to the substantial potential for financial exploitation.

Courts may appoint a guardian of both the person and estate when an individual requires comprehensive assistance across all life domains. Texas law also permits limited guardianships that restrict the guardian's authority to specific areas while preserving the ward's rights in other domains.

Professional Guardian Certification​

The Texas Judicial Branch Certification Commission (JBCC) oversees a comprehensive certification program for private professional guardians—individuals engaged in the business of serving as guardian for multiple wards. This certification requirement ensures that professional guardians meet minimum qualifications and maintain ongoing competency through continuing education.

To obtain certification, professional guardians must:

  • Be at least 18 years old and a U.S. citizen or legal resident
  • Undergo fingerprint-based criminal background checks
  • Complete JBCC-approved guardianship training covering legal responsibilities, financial management, ethical obligations, and court reporting requirements
  • Demonstrate relevant work experience or education in fields such as social work, law, finance, or healthcare administration

Certified guardians must complete 12 hours of continuing education every two years, including two hours of ethics training and one hour of legislative updates.

County Variation in Procedures​

Texas guardianship practice varies significantly across the state's 254 counties:

Statutory Probate Courts: The ten largest counties—Harris, Dallas, Bexar, Travis, Tarrant, Collin, Denton, Fort Bend, Hidalgo, and El Paso—maintain statutory probate courts with judges who exclusively handle probate and guardianship matters. These specialized courts typically provide faster case processing and judges bring deep expertise in guardianship law.

County Courts at Law: Mid-sized counties utilize county courts at law, where judges divide their attention among probate, guardianship, criminal, civil, and family law matters.

Constitutional County Courts: Smaller rural counties rely on constitutional county courts, where county judges (who need not be attorneys) handle guardianships alongside their administrative duties. These counties face the most significant resource constraints.

Local rules adopted by individual counties create additional procedural variations. Practitioners must consult each county's specific local rules in addition to statewide statutes.

Certificate of Medical Examination (CME)​

The Certificate of Medical Examination stands as the cornerstone of medical evidence required in Texas guardianship proceedings. This document provides the court with a professional clinical assessment of the proposed ward's cognitive and physical functioning, forming the evidentiary foundation for the court's determination of incapacity.

120-Day Timing Requirement​

Texas Estates Code Section 1101.103 establishes strict temporal requirements for the CME. The written letter or certificate from the examining healthcare provider must be dated not earlier than 120 days before the date the guardianship application is filed with the court.

Critically, both the CME document itself and the underlying physical examination on which it is based must occur within this 120-day window. A physician cannot rely on an examination performed four months before filing and simply write a current letter summarizing those findings—the actual clinical examination must be conducted no more than 120 days before the application filing date.

Intellectual Disability Exception: When intellectual disability forms the basis of alleged incapacity, the court may accept medical documentation based on examinations performed within 24 months before the hearing date, provided the examination was conducted by a physician or psychologist certified by the Health and Human Services Commission.

For detailed guidance on medical certificate timing requirements across multiple states, see our Medical Certificates for Guardianship Guide.

Qualified Examiner Categories​

Texas law designates three categories of healthcare professionals qualified to perform the medical examination and complete the CME:

Physicians: Medical doctors (M.D.) and doctors of osteopathic medicine (D.O.) currently licensed to practice in Texas constitute the primary category of qualified examiners. These physicians must hold active, unrestricted licenses issued by the Texas Medical Board.

Psychologists: For cases involving intellectual disability as the basis of alleged incapacity, psychologists licensed in Texas or certified by the Health and Human Services Commission may provide the required medical evidence.

Advanced Practice Registered Nurses: Texas law authorizes APRNs to conduct medical examinations and complete CMEs when acting under a physician's delegation authority and supervision in accordance with Chapter 157 of the Texas Occupations Code. This provision addresses access to care challenges, particularly in rural and underserved areas where physician shortages exist.

Required Content and Findings​

The Texas Estates Code mandates comprehensive CME content addressing specific statutory elements. Section 1101.103(b) requires:

Functional Assessment in Five Domains: The CME must describe the nature, degree, and severity of the proposed ward's incapacity, including functional deficits in:

  1. Handling business and managerial matters
  2. Managing financial matters
  3. Operating a motor vehicle
  4. Making personal decisions regarding residence, voting, and marriage
  5. Consenting to medical, dental, psychological, or psychiatric treatment

Specific Opinions: For motor vehicle operation and voting rights, the examiner must state their clinical opinion regarding whether the proposed ward has the mental capacity to vote in public elections and the ability to safely operate a motor vehicle.

Comprehensive Evaluation: The CME must provide a comprehensive evaluation of the proposed ward's physical condition and mental functioning, summarizing their medical history if reasonably available. This evaluation should address whether improvement in the proposed ward's condition is possible and recommend a specific time period for reevaluation.

Capacity Assessment: The CME must assess the ward's ability to:

  • Understand or communicate
  • Recognize familiar objects and individuals
  • Solve problems
  • Reason logically
  • Administer daily life activities with and without supports and services

Supports and Services Analysis: The CME must describe whether the proposed ward would benefit from supports and services that would allow them to live in the least restrictive setting, and explicitly address whether a guardianship is necessary and whether specific powers should be limited.

Medication Effects: The CME must state whether any current medications affect the proposed ward's demeanor or ability to participate fully in court proceedings.

APRN Supervision Requirements​

When an APRN conducts the medical examination and completes the CME, Texas law requires that the APRN act under a physician's delegation authority and supervision in accordance with Chapter 157 of the Texas Occupations Code.

Chapter 157 establishes a delegation framework under which physicians may delegate medical acts to qualified and properly trained APRNs. The delegating physician must establish a prescriptive authority agreement with the APRN that defines the scope of delegated activities, supervision requirements, and communication protocols.

Texas law requires that the supervising physician provide "continuous supervision" of the APRN's activities, though the statute explicitly provides that "the constant physical presence of the physician is not required". Continuous supervision may be satisfied through:

  • Direct telecommunication availability for consultation
  • Review of a designated percentage of the APRN's medical charts
  • On-site presence with the APRN at specified intervals

For guardianship CMEs specifically, the supervising physician must sign the certificate to verify their supervisory relationship and their agreement with the findings and recommendations.

Guardianship Application Process​

The formal process of establishing a guardianship in Texas involves multiple procedural steps designed to protect the rights of the proposed ward while enabling courts to make informed decisions.

Petition Requirements​

The guardianship process commences when an interested party files an application for guardianship with the appropriate probate court. The application must include:

  • Proposed ward's name, current address, and identifying information
  • Whether guardianship of the person, estate, or both is sought
  • Information about the proposed ward's property for estate guardianships
  • Identification of the proposed guardian and their qualifications
  • Certificate of Medical Examination dated within 120 days before filing
  • Affidavit containing contact information for all individuals entitled to notice

Texas Estates Code Section 1104.102 establishes priority for guardian appointments:

  1. Person designated in a Declaration of Guardian in Advance of Need
  2. The ward's spouse
  3. The ward's next of kin
  4. Any other eligible person best qualified to serve

Notice and Citation Procedures​

Upon filing of a guardianship application, the court clerk must issue a citation stating that the application was filed and citing all persons interested in the proposed ward's welfare to appear if they wish to contest the application.

Texas law mandates several distinct notice mechanisms:

Personal Service on Proposed Ward: The sheriff or other officer must personally serve citation on the proposed ward, ensuring they receive actual notice.

Mail Notice to Interested Parties: The applicant must provide notice by registered or certified mail to the proposed ward's spouse, parents (if the ward is a minor), adult siblings, adult children residing in Texas, facility administrators, and any person designated in a declaration of guardian.

Posting: The citation must be posted at the county courthouse door before the return day.

The attorney representing the applicant must file an affidavit of notice compliance before the hearing.

Court Investigator Role​

In statutory probate courts serving the largest Texas counties, court investigators play a crucial role. The court investigator represents the court itself—not the applicant, the proposed ward, or the attorney ad litem—and provides the judge with an independent, objective assessment.

Court investigator duties include:

  • Conducting face-to-face interviews with the proposed ward, applicant, proposed guardian, family members, and caregivers
  • Visiting the proposed ward at their current residence
  • Filing a written report with findings and recommendations addressing:
    • Whether the proposed ward meets the legal definition of incapacitated person
    • Whether less restrictive alternatives are available and feasible
    • Whether the proposed guardian is suitable
    • What type and scope of guardianship is appropriate

Court investigators also oversee Court Visitor Programs that provide long-term monitoring of established guardianships.

Hearing Preparation​

All required documentation must be filed before the hearing, including the application, CME, proof of service, and attorney affidavit of notice compliance.

Proposed Guardian Prerequisites:

  • Complete mandatory guardianship training through the JBCC at least ten days before the hearing
  • Undergo a criminal background check through the JBCC registration system
  • Obtain a certificate of completion to file with the court

At the hearing, the applicant's testimony should address:

  • Their relationship to the proposed ward
  • Specific instances within the six months before the hearing demonstrating incapacity
  • The proposed ward's diagnosis and condition
  • Why less restrictive alternatives are insufficient
  • The proposed guardian's qualifications

If the court grants the application, the judge signs an Order Appointing Guardian specifying the type of guardianship, whether it is full or limited, the bond amount, and any special conditions.

Person vs. Estate Guardianship​

Different Documentation Needs​

Estate Guardianships involve substantially more rigorous documentation requirements:

Inventory, Appraisement, and List of Claims: Within 30 days after qualifying (or up to 90 days), the guardian of the estate must file this sworn document providing:

  • Complete inventory of all property belonging to the ward
  • Appraisement of fair market value of each item
  • Complete list of all claims due or owing to the estate

The inventory must distinguish between real property and personal property, provide legal descriptions of real estate, itemize personal property with sufficient detail, and specify account numbers for financial accounts.

Ongoing Financial Records: Guardians of the estate must maintain meticulous records of all receipts and disbursements, investment transactions, account statements, and property management activities.

Guardians of the Person face less burdensome documentation requirements, focusing on records of the ward's living situation, medical care, and general welfare rather than detailed financial records.

Power Limitations​

Guardian of the Person Authority:

  • Establish the ward's legal domicile
  • Consent to medical, psychiatric, and dental treatment
  • Make decisions about daily living arrangements and activities
  • Consent to the ward's marriage (if ward retains capacity)

Restrictions: Guardians of the person may not unreasonably restrict the ward's right to visit with family members, receive visitors, communicate with others, receive or send correspondence, or deny access to a monthly personal allowance.

Guardian of the Estate Authority (without specific court authorization):

  • Collect all debts and claims due to the ward
  • Possess and manage all property
  • Vote stocks by proxy
  • Pay calls and assessments on investments
  • Insure estate property
  • Pay routine taxes, court costs, and bond premiums

Requires Court Approval:

  • Purchase or exchange estate property
  • Sell real or personal property
  • Make gifts from the estate
  • Establish a monthly allowance for the ward's support
  • Pay claims against the estate
  • Borrow money on behalf of the estate
  • Lease estate property for terms beyond the current year
  • Invest estate funds
  • Settle lawsuits

Reporting Requirements​

Guardians of the Estate: Texas Estates Code Section 1163.001 mandates annual accountings filed within 60 days after each anniversary of the guardian's appointment, including:

  • Complete accounting of all receipts and disbursements
  • Current balances of all accounts
  • Complete list of estate assets with current values
  • Any changes in estate property or claims

Guardians of the Person: Texas does not impose statewide annual reporting requirements—requirements vary by county. Many counties require Annual Reports on Location, Condition, and Well-Being of Ward through local rules or standing orders.

For comprehensive guidance on annual guardianship reporting requirements across multiple states, see our Annual Guardianship Reports Guide.

Combined Guardianship Options​

Courts frequently appoint guardians of both the person and estate when wards require comprehensive assistance. Combined guardianships:

  • Eliminate the need for separate guardians to coordinate activities
  • Enable integrated decisions about care and financial resources
  • Concentrate substantial power in a single individual's hands

The decision whether to seek combined or separate guardians should consider:

  • Whether a single individual possesses both caregiving skills and financial management expertise
  • Whether family dynamics favor consolidating authority or separation of powers
  • The complexity and size of the estate
  • The ward's preferences

Professional Guardian Requirements​

Certification Programs​

The JBCC operates a three-tier certification system:

Provisional Certification: Entry pathway requiring minimum age, citizenship/residency, criminal background checks, and JBCC-approved training. Provisionally certified guardians may accept appointments but face certain practice restrictions.

Full Certification: Requires relevant education or experience in social work, nursing, counseling, finance, law, or business management. Must be renewed every two years.

Master Certification: Highest level requiring extensive experience, advanced training, and positive judicial recommendations.

The JBCC maintains an online database of certified guardians that courts and the public may search to verify certification status.

Bonding Requirements​

Texas law mandates that guardians of the estate post bonds before receiving letters of guardianship. The court sets bond amounts based on the estate's liquid assets plus anticipated annual income.

Exceptions (no bond required if):

  • The guardian is a corporate fiduciary with capital and surplus exceeding specified amounts
  • The guardian serves as guardian of the person only
  • The court finds assets are adequately protected and all persons entitled to notice waive the bond requirement
  • The ward's will or a surviving parent's declaration directs no bond

Bond Types:

  • Personal bonds (guardian pledges own assets)
  • Personal bonds with sureties (other individuals pledge assets)
  • Bonds with corporate sureties (insurance companies issue surety bonds)
  • Cash deposits with the court

Bond premiums typically range from 0.5% to 3% of the bond amount annually, paid by the guardianship estate.

Continuing Education​

All certified guardians must complete 12 hours of continuing education every two years:

  • Two hours of ethics and professional responsibility
  • One hour of legislative updates
  • Nine hours of any guardianship-related topics from JBCC-approved providers

Guardians may carry forward up to four hours of excess CE credits (but not ethics or legislative update hours).

Oversight and Accountability​

Professional guardians operate under multilayered oversight:

JBCC Monitoring: Compliance with certification requirements, investigation of complaints, disciplinary sanctions ranging from reprimands to certification revocation.

Code of Ethics and Minimum Standards: Professional conduct requirements addressing conflicts of interest, commingling of funds, self-dealing, duty of loyalty, confidentiality, and other standards.

Annual JBCC Reports: Professional guardians must submit annual reports for each guardianship they administer.

Court Supervision: Filing annual reports and accountings, appearing at review hearings, obtaining court approval before major decisions.

County-Specific Procedures​

Large County vs. Rural Differences​

Statutory Probate Courts (large counties) provide:

  • Judges with deep guardianship expertise
  • Dedicated court staff familiar with procedures
  • Faster case processing (hearings within 2-4 weeks)
  • Systematic monitoring programs (court investigators, court visitors)

Rural Courts face:

  • Limited staff and competing demands from other case types
  • Longer waits for hearing dates (potentially months)
  • No dedicated court investigators
  • Limited ongoing monitoring of guardianships

Local Form Variations​

Many statutory probate courts publish comprehensive guardianship form packets on their websites. Form content and requirements vary among counties:

  • Different caption styles and formatting requirements
  • Varying levels of detail required in applications
  • County-specific CME form variations
  • Different guardian information sheets and instruction packets

Practitioners should always check the specific county's website for current forms before preparing documents.

Filing Procedures​

Statutory Probate Court Counties: Applications filed with the probate court clerk.

Other Counties: Applications typically filed with the county clerk, who assigns cases to the appropriate court.

Filing Fees: Vary substantially among counties—large counties generally charge $300-$400 for applications.

Electronic Filing: Available in some large counties through eFileTexas; other counties require paper filings.

Court Preferences​

Individual judges develop preferences affecting case proceedings:

  • Level of detail preferred in applications
  • Evidentiary standards and hearing formality
  • Approaches to limiting guardianships and considering alternatives
  • Bond amount calculations
  • Reporting and review hearing requirements

Practitioners should consult experienced local attorneys, review local rules thoroughly, and observe hearings when possible.

Annual Reporting (Where Required)​

County-Specific Requirements​

Texas does not impose comprehensive statewide annual reporting for guardians of the person. Requirements vary:

Statutory Probate Courts typically require annual reports through local rules or standing orders with standardized forms addressing the ward's living arrangements, health status, medical care, activities, and condition changes.

Mid-sized and Rural Counties vary—some require annual reports, others do not systematically collect this information.

Annual reporting requirements are typically specified in the order appointing the guardian.

Content Expectations​

Estate Guardians: Annual accountings must detail:

  • All property received with sources and amounts
  • All disbursements with purposes and payees
  • Gains or losses on investments
  • Current account balances
  • Current inventory of estate property with valuations
  • Any changes in estate composition

Person Guardians: Annual reports typically address:

  • Current residence and appropriateness
  • Physical and mental health status
  • Medical care received
  • Social engagement and activities
  • Concerns about care or safety
  • Assessment of whether guardianship should continue

Financial Accountability​

The annual accounting requirement serves as a critical accountability mechanism:

  • Courts scrutinize disbursements to ensure they benefit the ward
  • Guardians must maintain separate accounts and avoid commingling
  • Investment prudence is evaluated against the "prudent person" standard
  • Failure to file timely accountings may result in show cause orders, removal, and liability

Status Reporting​

Status reports enable courts to:

  • Monitor whether wards receive appropriate care
  • Identify concerns about inadequate care, unsafe conditions, or neglect
  • Assess whether less restrictive alternatives might now be appropriate
  • Consider guardianship modification or termination when conditions improve

Automating Texas Guardianship Forms​

AI-Powered CME Tracking and Form Automation

Instafill.ai can track CME timing requirements, verify that certificates address all statutory elements, and populate Texas guardianship applications while adapting to county-specific form variations. This automation reduces the risk of expired CMEs and missing documentation elements that delay case processing.

CME Processing and Tracking​

AI-powered calendar and deadline management systems can:

  • Track CME examination dates automatically
  • Calculate the 120-day filing deadline
  • Provide alerts at appropriate intervals (90, 60, 30 days before expiration)
  • Verify that completed CME forms address all required statutory elements under Section 1101.103(b)
  • Flag missing or inadequate responses before filing
  • Verify APRN forms include required supervising physician signatures

Application Package Preparation​

Document automation systems can populate application packages from a single data entry point:

  • Guardianship application
  • Proposed order appointing guardian
  • Guardian information sheets
  • Notice forms for service
  • Attorney affidavit of notice compliance

Systems can incorporate jurisdiction-specific logic—for example, alerting users when intellectual disability cases may use the 24-month examination window instead of 120 days.

County-Specific Adaptation​

Sophisticated automation systems can maintain databases of county-specific requirements:

  • Which court handles guardianship cases
  • Current filing fees and accepted payment methods
  • Electronic filing availability
  • Required number of copies
  • Specific form templates and formatting requirements
  • Caption styles and local rules
  • Typical case processing timelines

Based on the county selected, the system automatically applies appropriate formatting and generates correct forms.

Deadline Compliance​

Automated deadline management provides systematic tracking for:

  • Annual report due dates (typically 60 days after each anniversary)
  • Annual accounting deadlines
  • Hearing dates
  • Continuing education requirements for certified professional guardians

Systems can integrate with practice management software and deliver reminders through multiple channels—calendar notifications, email alerts, text messages, and dashboard notifications.

Conclusion​

Texas guardianship law creates a comprehensive protective framework for incapacitated persons while emphasizing individual autonomy and least restrictive alternatives. The Certificate of Medical Examination serves as the evidentiary foundation for capacity determinations, with strict 120-day timing requirements and detailed content mandates ensuring courts receive current, comprehensive clinical assessments.

The distinction between person and estate guardianships enables tailored appointments matching guardian authority to ward needs, while professional guardian certification requirements ensure qualified, trained fiduciaries serve vulnerable populations. County variations in procedures, courts, and resources create complexity that practitioners must navigate carefully.

Automation technologies offer significant potential to manage procedural complexity, ensure deadline compliance, adapt to county-specific requirements, and improve accuracy in guardianship practice—helping attorneys, guardians, and families navigate Texas guardianship requirements more efficiently while improving outcomes for incapacitated persons.