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Massachusetts MPC 401: Termination Medical Certificate

The MPC 401 supports a petition to end a Massachusetts guardianship, conservatorship or both on the ground that the person no longer meets the standard for the appointment. The examining clinician checks which standard no longer applies and describes in detail the clinical and functional findings that support discharge. If termination is sought for any other reason, the court requires the full MPC 400 medical certificate instead.

Who completes it

A registered physician, licensed psychologist, certified psychiatric nurse clinical specialist or nurse practitioner who personally examined the person completes the whole three-page certificate and signs it under the penalties of perjury.

Submitting and payment

How to submit it
The certificate is filed with the Probate and Family Court together with the petition to terminate. It must be signed and dated by the clinician but does not need to be notarized.

Good to know

  • For guardianship, the clinician certifies that the person no longer has a clinically diagnosed condition preventing them from meeting essential requirements for physical health, safety or self-care.
  • For conservatorship, the form offers two findings: property will no longer be wasted without management, or protection is no longer needed to obtain money for the person's support and care.
  • The certifications page records whether the person is under your continuing care, other information sources such as records or family, anyone who helped prepare the report, and relevant tests with dates.

Get the official form

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

Medical Certificate for Termination of Guardianship and/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 sign the Massachusetts MPC 401?

A registered physician, a licensed psychologist, a certified psychiatric nurse clinical specialist or a nurse practitioner. The signer states their specialty or experience, certifies an in-person clinical evaluation, and signs under the penalties of perjury with license type, number and date.

When should the MPC 400 be used instead of the MPC 401?

The MPC 401 is only for termination because the person no longer meets the standard for guardianship or conservatorship. If termination is sought for any other reason, the form directs the clinician to complete the MPC 400 Medical Certificate Guardianship or Conservatorship instead.

Does the MPC 401 need to be notarized?

No. The clinician signs and dates it under the penalties of perjury and adds office details and license information. The clinician also records whether they told the person before the examination that communications would not be privileged, and explains if they did not.