In a Texas guardianship of an adult, the court cannot decide incapacity based on family concern alone. It needs medical evidence. That evidence usually begins with a document called the Certificate of Medical Examination, often shortened to the CME. For New Braunfels and Comal County families, getting this certificate right, and on time, is one of the most important things a guardianship lawyer helps with. A vague or outdated certificate is one of the most common reasons a guardianship case stalls.
What the Certificate Is For
The Certificate of Medical Examination is a written report from a physician, filed with the court, that describes the proposed ward’s physical and mental condition and explains how that condition affects their ability to make decisions. The judge relies on it, along with testimony, to decide:
- whether the person is incapacitated,
- whether a guardianship should be full or limited,
- which rights the person can keep,
- whether the person can attend the hearing,
- whether the person has the capacity to vote, drive or make other specific decisions.
The certificate is not a formality. It shapes the scope of the entire guardianship.
The 120-Day Timing Rule
The physician’s certificate is generally required to be based on an examination performed within 120 days before the guardianship application is filed. That window is the most common trap we see.
Practical tips:
- Schedule the exam after you have talked with a guardianship attorney, not months before.
- Ask the doctor’s office how long it takes to complete forms. Some clinics need two to three weeks.
- Plan to file promptly after the certificate is signed.
- If you are filing for a young adult before age 18, coordinate the exam with the 180-day pre-birthday filing window. Our turning 18 page covers that timing.
What the Certificate Typically Covers
Courts generally use a standard certificate form that asks the physician to address a series of specific questions. While forms vary somewhat, the physician is generally asked to describe:
The person’s condition
- the diagnosis and its likely course,
- whether the condition is likely to improve or get worse,
- current medications and how they affect the person’s thinking,
- any evaluations or testing performed.
Abilities and limits
- the person’s ability to understand and communicate decisions,
- whether they can handle money, pay bills and avoid exploitation,
- whether they can consent to medical care and take medications properly,
- whether they can make decisions about where to live,
- whether they can safely drive,
- whether they have the capacity to make personal decisions about voting or marriage.
Practical matters
- whether the person can attend a court hearing and understand it,
- whether the person’s condition is a result of dementia, and whether a memory-care setting is needed,
- whether the person would benefit from supports or services that could reduce the need for a guardianship.
For intellectual disability, Texas law can require additional information, such as a determination of intellectual disability or other qualified testing. We help families gather school psychological evaluations and other records when they are relevant.
Choosing the Right Physician
The best certificate comes from a doctor who:
- knows the patient, ideally over months or years,
- has seen changes and can describe specific examples,
- is willing to fill out every section of the form carefully,
- can be reached if the court has follow-up questions.
A primary care doctor in New Braunfels often works well. For dementia, a neurologist or geriatric physician may give a more detailed picture. For a young adult with a developmental disability, a longtime pediatrician or family doctor can often help, along with records from psychologists or schools. If your loved one lives in a memory-care or assisted-living community in Comal County, a visiting physician there may also be an option.
Common Problems That Delay Cases
These issues come up often:
| Problem | What to do |
|---|---|
| Exam more than 120 days before filing | Schedule a new exam |
| Doctor checks boxes but gives no explanation | Ask the doctor to add specifics |
| Certificate does not address retained rights such as driving or voting | Return it for completion |
| Doctor recommends a full guardianship without explaining why | Ask for the reasons, or consider a limited guardianship |
| Physician unwilling to complete forms | Find another physician early |
When a certificate is incomplete, the court or the attorney ad litem may push back, and you may have to start over. It is worth the extra effort up front.
When Your Loved One Refuses an Exam
Many older adults resist seeing a doctor, especially if they suspect the visit is about their independence. A few approaches families find helpful:
- Pair the exam with a routine appointment, such as an annual wellness visit.
- Let the doctor lead the conversation, rather than family members.
- Avoid framing it as a test the person can fail.
If none of this works and the situation is serious, the court can order an examination once the case is filed. In emergencies, a temporary guardianship may be possible while the medical evidence is developed.
How the Certificate Fits Into the Larger Case
The certificate is one piece of evidence among several. The judge will also hear from the person seeking appointment and may hear from the attorney ad litem, other family members, and the proposed ward. Texas also requires proof of recurring acts or occurrences showing incapacity, not just a diagnosis. A strong case lines up the medical findings with real-life examples.
The certificate can also support a lighter-touch result. If the doctor explains that the person can still make certain decisions, the court can tailor a limited guardianship or consider alternatives to guardianship instead.
For the full order of events, see our guardianship process page. If your loved one is living with memory loss, our dementia and Alzheimer’s page addresses the medical questions that come up most often in those cases.
Medical Evidence Later in the Guardianship
The physician’s role does not end at the first hearing. If the ward’s condition improves, a new medical certificate is usually part of a request to restore capacity or modify the guardianship. A guardian of the person also reports on the ward’s medical condition each year, and physician input helps the court decide whether the guardianship should continue as is.
Talk With a New Braunfels Guardianship Lawyer About Medical Evidence
Our team works with Comal County families to plan the timing of the exam, explain the form to the physician’s office, and review the certificate before filing so problems are caught early. We offer a free consultation by phone, video or in person, and we speak Spanish. Call (830) 302-4071.
Frequently Asked Questions
Can any doctor sign the Certificate of Medical Examination?
The certificate must be completed by a licensed physician. If you are unsure whether a particular doctor qualifies, ask your attorney before scheduling the exam. A doctor who knows the patient well is usually the best choice, because they can describe changes over time.
What if the exam is more than 120 days old?
The certificate generally must be based on an exam within 120 days before the application is filed. If the exam is older, a new exam is usually needed before filing, so plan the appointment with the filing date in mind.
What if my parent refuses to see a doctor?
This happens often. Sometimes a regular checkup with a familiar physician goes smoothly. If not, the court can order an examination after the case is filed. We can talk through options that respect your parent’s dignity.
Does the doctor have to come to court?
In many uncontested cases, the written certificate is enough. If the case is contested or the certificate leaves important questions unanswered, the physician may need to testify, sometimes by deposition or remotely if the court allows it.
Last reviewed November 13, 2026. General information only, not legal advice.