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Massachusetts MPC 403: Medical Certificate Affidavit

The MPC 403 lets a clinician confirm that a person in a Massachusetts guardianship or conservatorship case remains medically stable as described in the most recently filed Medical Certificate, particularly its diagnosis and stability findings, so a new MPC 400 is not needed. The clinician examines the person, reviews that earlier certificate and swears that its diagnosis and statements about decision-making and function remain true.

Who completes it

A registered physician, licensed psychologist, certified psychiatric nurse clinical specialist or nurse practitioner who examined the person and reviewed the most recent medical certificate completes and signs the one-page affidavit under the penalties of perjury.

Submitting and payment

How to submit it
The signed affidavit is filed with the Probate and Family Court in the pending guardianship or conservatorship case.

Good to know

  • It cannot be used at a permanent appointment unless counsel for the incapacitated or protected person has been appointed and does not object, under Standing Order 2-10.
  • The clinician certifies continuous care since a stated date, no significant change in diagnoses, decision-making or function, and the same residence with no acute admission affecting those findings.
  • Enter the date of the most recently filed medical certificate; the affidavit incorporates that certificate's diagnosis and statements rather than repeating them.

Get the official form

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

Medical Certificate Affidavit

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

When can the MPC 403 replace a new MPC 400?

When the person has been and remains medically stable as indicated on the most recently filed Medical Certificate. At a permanent appointment it can be used only if counsel for the person has been appointed and does not object, so otherwise the court expects a new MPC 400.

Who can sign the Massachusetts MPC 403?

A registered physician, a licensed psychologist, a certified psychiatric nurse clinical specialist or a nurse practitioner. The signer gives the examination date, the date of the medical certificate reviewed, and the date continuous care began, and certifies under the penalties of perjury.

Is the MPC 403 a full medical certificate?

No. It is a one-page affidavit that incorporates the most recent Medical Certificate rather than repeating the diagnosis, functional findings and incapacity analysis. If diagnoses, decision-making or functional abilities have changed significantly, the court needs a new MPC 400 describing the current condition.