Nurse Practitioners Certificate {CC-GN-050}

CC-GN-050 - NURSE PRACTITIONER’S CERTIFICATE (Md. Rule 10-202(a)). A petitioner will use this certificate in a legal proceeding to request a guardian for the patient named below. The petitioner must submit the original certificate. Your answers must be specific and detailed and based on your personal examination or evaluation of the patient. Address each issue contained in the certificate that may interfere with the patient’s ability to make responsible decisions about health care, food, clothing, shelter, or property. You may complete the form yourself or have another person fill it out under your supervision. You must sign the certificate. Your testimony about its contents may be required at a hearing. Attach additional sheets, if necessary. www.FormsWorkflow.com