Connecticut probate courts may request this evaluation when a conservator of the person or estate is sought for a respondent with intellectual disability, or when an existing conservatorship for an adult with intellectual disability is reviewed. The psychologist states whether the patient meets the C.G.S. 1-1g definition and how the disability affects decisions about medical care, living environment, finances and safety.
A psychologist licensed in Connecticut who personally examined the patient on the stated date completes and signs the whole form, noting whether they are a treating psychologist and for how long.
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Psychologist's Evaluation/Conservatorship of Person with Intellectual Disability
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The instructions explain that a significant limitation in intellectual functioning means an IQ more than two standard deviations below the mean on standard tests, which means 69 or less. The adaptive behavior deficits must have originated before age 18.
That they are a licensed psychologist, that they personally examined the respondent on the stated date, and that they told the patient all communications, records and information from the examination will be disclosed to a third party. They then sign, print their name and date it.
PC-370 is the physician's evaluation for conservatorship generally. PC-372 is completed by a licensed psychologist for a respondent with intellectual disability and adds questions on whether the C.G.S. 1-1g definition is met and whether a psychological evaluation supports that conclusion.