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Massachusetts MPC 400: Guardianship Medical Certificate

The Massachusetts Probate and Family Court uses the MPC 400 to decide whether to appoint a guardian, a conservator or both, and how far that authority should reach. The seven-page certificate documents the diagnosed condition, decision-making impairment, retained abilities, values and preferences, risks, placement, treatment needs and whether the person can attend the hearing. It is not used for a person with an intellectual disability.

Who completes it

A registered physician, licensed psychologist, certified psychiatric nurse clinical specialist or nurse practitioner who personally examined the person within 30 days of filing completes every applicable section and signs under the penalties of perjury, with license type, number and date. No notarization is needed.

Submitting and payment

How to submit it
The clinician returns the signed certificate to the petitioner, who files it with the Probate and Family Court, where it is impounded. Narrative fields expand when the form is completed on a computer.

Good to know

  • The court prefers limited guardianship and conservatorship, so sections 3.1 and 3.2 ask for retained abilities, such as handling an allowance or expressing treatment choices, as well as areas needing help.
  • Complete section 3.1 only if guardianship is sought and section 3.2 only if conservatorship is sought; all other sections and pages must be completed.
  • Explain medical terms and abbreviations in plain language, and name in the certification section anyone whose information you relied on, such as family members or other clinicians.
  • Before the examination, tell the person that communications will not be confidential, and record on page 1 whether you did, explaining if not.

Get the official form

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

Medical Certificate Guardianship or Conservatorship

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 Massachusetts MPC 400?

A registered physician, licensed psychologist, certified psychiatric nurse clinical specialist or nurse practitioner. The clinician must have personally examined the person within 30 days of the date the certificate is filed, states their specialty or experience on page 1, and signs under the penalties of perjury.

What does the MPC 400 ask about medications and prognosis?

Section 1D lists every medication with dosage and schedule, with a checkmark for any antipsychotic, and asks whether any could impair mental functioning. Section 1C asks whether the condition is likely to change substantially within 90 days and about reversible factors such as delirium, acute illness, drug interactions, hearing or vision loss, or bereavement.

Is the MPC 400 used for intellectual disability guardianships?

No. The form itself says not to use it when guardianship or conservatorship is sought for a person with an intellectual disability. Those cases need the Clinical Team Report (MPC 402), completed by a licensed psychologist, registered physician and licensed social worker.