Get Medical Certificate Affidavit

Filling out the Medical Certificate Affidavit online can simplify the process of providing necessary medical documentation. This guide offers clear and supportive steps to ensure users can successfully complete the form with confidence.

Follow the steps to complete the Medical Certificate Affidavit online.

1. Click ‘Get Form’ button to obtain the Medical Certificate Affidavit and open it in your preferred online editor.
2. In the section labeled 'Docket No.', enter the relevant case number unless otherwise instructed.
3. Indicate the division of the court, specifying the appropriate area for your filing.
4. Address the affidavit to 'The Honorable Justices of the Probate and Family Court'.
5. Under the section that begins with 'The undersigned hereby certifies under the penalties of perjury that:', select your professional designation from the following options: a registered physician, a licensed psychologist, a certified psychiatric nurse clinical specialist, or a nurse practitioner.
6. Fill in the area of specialization, if applicable, following your designation.
7. Provide the name of the person you examined, including their first name, middle name, and last name.
8. Indicate the age of the individual examined.
9. Enter the date of the examination(s) conducted.
10. Confirm the date of the most recently filed medical certificate.
11. Certify that the prior diagnosis and statements are accurate based on your examination and the review of previous documents.
12. Indicate the date you began providing continuous care to the individual.
13. Affirm that there have been no significant changes in diagnoses or functional abilities since the last examination.
14. State the setting of residence for the individual and confirm whether there have been any acute medical admissions.
15. Certify the completeness and accuracy of the report based on your professional competence.
16. Finally, sign and date the affidavit in the appropriate sections, and include your printed name and office address.
17. Once all fields are complete, save your changes, and utilize options to download, print, or share the completed Medical Certificate Affidavit as needed.

Get started on completing your Medical Certificate Affidavit online today!