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This Statement of Expert Evaluation is to be filed with or attached to: A. Guardianship Application: Completed by. Licensed Physician or.You must complete this evaluation in its entirety to avoid unnecessary denial of nursing care. Return completed form to appropriate BWC customer service office. Guardian's Report: Statement of Expert Evaluation completed by: Licensed Physician Licensed. NOTE: The evaluations upon which this Report is based must have been performed within three (3) months of the date the Petition for guardianship is filed. 1. CA-1, the employee should detach Form CA-20 and complete items 1-3 on the front. Guardian's Report: Statement of Expert Evaluation completed by: Licensed Physician Licensed. Have your physician complete the other sections. You may complete the form yourself or have another person fill it out under your supervision.