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Maryland CC-GN-019: Guardianship Capacity Assessment

Maryland circuit courts use the CC-GN-019 to decide whether an adult needs a guardian of the person, of the property, or both, and to identify less restrictive alternatives that could limit or replace a guardianship. A clinician meets it when a petitioner asks for an assessment of someone's functional capacity to make and communicate decisions. The October 2026 revision replaces the older physician and psychologist certificate.

Who completes it

Only a licensed physician, psychologist, physician assistant, LCSW-C or nurse practitioner who personally examined or evaluated the individual may complete it, and they must complete and sign the whole eight-page certificate themselves.

Submitting and payment

How to submit it
The certificate is filed with the circuit court along with the guardianship petition; two certificates are generally required, and the signer may be asked to testify about the assessment at a hearing.

Good to know

  • Every section must be answered: write Not applicable or N/A where the assessment does not support an opinion, because the court may reject a certificate with a blank section.
  • Part I records where and how the evaluation happened, including remote assessments with audio and visual access, who was present, assistive devices, tests, collateral sources and records reviewed.
  • Parts III and IV rate cognitive domains and everyday activities (ADLs, home and community, medical and financial tasks) on scales from intact or independent to severe impairment or unable.
  • Part V asks which interventions, such as training, home services, assistive devices or therapy, would help, which supports the court's search for alternatives to guardianship.

Get the official form

Download the current version from the source each time; forms change without notice.

Certificate – Guardianship Capacity Assessment

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who can complete the Maryland guardianship capacity certificate?

A licensed physician, psychologist, physician assistant, licensed clinical social worker-clinical (LCSW-C) or nurse practitioner. The certificate must be based on the clinician's own examination or evaluation of the individual, and the clinician must complete and sign it personally, affirming its contents under the penalties of perjury.

Can the CC-GN-019 assessment be done remotely?

Yes. Part I includes a box for evaluations done remotely with audio and visual access to the individual, along with the dates, length and the reason for the remote assessment. In-person settings such as a facility or the individual's residence are listed separately.

What happens if part of the CC-GN-019 is left blank?

The form warns that the court may reject the certificate if a section is left blank. Where the assessment does not allow an opinion, the clinician should explain why or write Not applicable or N/A, and may attach additional documents when the space is not enough.