This attachment lets a clinician tell a California probate court how well a proposed conservatee can perform activities of daily living and instrumental activities of daily living. It goes with the Confidential Capacity Assessment and Declaration (GC-335) and rates abilities from fully independent to unable even with assistance across hygiene, nutrition, self-protection, finances, medical decisions and home and community life.
A California-licensed physician, psychologist, nurse practitioner, physician assistant, registered nurse, clinical social worker, occupational therapist or other licensed professional completes and signs it. The signer either completed the GC-335 assessment or took part in it.
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Everyday Activities Attachment to Confidential Capacity Assessment and Declaration—Probate Conservatorship
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No. The Judicial Council approved GC-335A for optional use. A clinician completing GC-335 can refer to it in item 19 to give more detail on how mental function deficits affect the person's ability to perform everyday activities.
Yes. A licensed professional who works or consults with the clinician who completed GC-335 and participated in that assessment may complete it, basing conclusions on that participation. Eligible professions include nurse practitioners, registered nurses, clinical social workers and occupational therapists.
Item 11 rates keeping a reasonably safe and clean home and arranging repairs, recognizing common hazards such as a hot stove or poisons, accessing transportation, and initiating and following a daily schedule. Item 12 allows other information on significant impairments.