Dec282025
Guardianship Q&A Series

How can my parents obtain adult guardianship for an adult sibling with lifelong disabilities, and what medical evaluations or records should we gather to support the petition? – North Carolina

Short Answer

In North Carolina, parents typically obtain adult guardianship by filing (1) a petition asking the Clerk of Superior Court to adjudicate the adult as incompetent and (2) an application to be appointed as guardian (of the person, of the estate, or both). Medical records help, but the court can also order a “multidisciplinary evaluation” through a designated agency, and that evaluation is often central evidence at the incompetency hearing. Practical records to gather focus on diagnosis, day-to-day functioning, and the adult’s ability to understand and communicate medical and financial decisions.

Understanding the Problem

In North Carolina, can parents get court authority to make medical and financial decisions for an adult child with lifelong intellectual disabilities when healthcare providers require the adult child’s consent to share information or accept decisions? The decision point is whether the adult meets North Carolina’s court standard for incompetency so that the Clerk of Superior Court can appoint a guardian with clearly defined powers. The process generally requires a court filing, formal notice, an attorney appointed to represent the adult in the case, and a hearing before the clerk.

Apply the Law

North Carolina adult guardianship usually happens in two linked stages handled by the Clerk of Superior Court: (1) an incompetency proceeding, and (2) an appointment of a guardian. The court can consider medical and functional evidence, and it can order a current multidisciplinary evaluation to help determine the nature and extent of the adult’s disability and the level of guardianship needed. North Carolina law also requires the petition to address less restrictive alternatives and explain why they do not meet the adult’s needs.

Key Requirements

  • File the correct requests with the clerk: A verified incompetency petition starts the case, and an application asks the clerk to appoint a guardian (guardian of the person, guardian of the estate, or a general guardian).
  • Provide facts showing decision-making limits (not just a diagnosis): Evidence should show the adult’s ability (or inability) to understand information, appreciate consequences, communicate choices, and manage personal care and/or finances.
  • Follow the required notice and hearing procedure: The adult must receive personal service, next of kin must receive mailed notice, counsel/guardian ad litem is appointed, and the hearing is set on a statutory timeline that can be extended for evaluations or mediation.

What the Statutes Say

Analysis

Apply the Rule to the Facts: Here, the parents report a lifelong genetic disorder and intellectual disabilities, shared living arrangements, and a long history of the parents handling medical and financial decisions. The recent refusal by a hospital to share information without the adult child’s consent fits a common trigger for guardianship planning: providers must follow privacy and consent rules unless a legally authorized decision-maker exists. The strongest petition support will connect the disability to specific functional limits (understanding/communicating choices, appreciating consequences, managing health and money) and explain why less restrictive options do not reliably work in emergencies.

Process & Timing

  1. Who files: A parent (or another interested person). Where: The Clerk of Superior Court in the county where the adult resides in North Carolina. What: A verified petition to adjudicate incompetence, usually filed with an application to appoint a guardian (and any local cover sheets the county requires). When: The clerk must issue notice promptly; the hearing is typically set within the statutory window after service, but it can be continued for good cause, a multidisciplinary evaluation, or mediation.
  2. Service and representation: The adult must be personally served with the petition and the notice of hearing, and an attorney is appointed as guardian ad litem unless the adult hires counsel. Next of kin listed in the petition receive mailed notice.
  3. Evidence and hearing: The parties present medical/functional evidence at the incompetency hearing. If the clerk orders a multidisciplinary evaluation through a designated agency, the agency generally must file it within 30 days after it receives the clerk’s order, and the evaluation can be considered at the hearing.

What medical evaluations or records to gather (practical checklist)

  • Recent clinician records that describe functional limitations: Office visit notes, discharge summaries, care plans, and specialty notes that discuss cognition, communication, judgment, and the ability to understand/consent to treatment.
  • Neuropsychological or psychological testing (if available): Prior IQ/adaptive testing, developmental evaluations, or updated cognitive testing that explains how the condition affects decision-making.
  • Adaptive functioning documentation: Records from school transition planning, vocational rehabilitation, day program assessments, or disability services that address daily living skills (money handling, medication management, safety awareness).
  • Hospital records from the recent admission: Admission/discharge paperwork and any notes reflecting confusion, inability to provide informed consent, inability to relay history, or need for a surrogate decision-maker.
  • Medication and treatment summaries: Current medication list, treating provider list, and a brief summary of ongoing medical needs (especially anything that creates urgent decisions).
  • Benefits and financial picture (for estate powers): Proof of income sources (for example, disability-related benefits statements), banking information summaries, recurring bills, and any assets/liabilities. The application typically asks for a general statement of assets and liabilities.
  • Less restrictive alternatives tried or considered: Any attempted HIPAA releases, supported decision-making arrangements, representative payee documentation, or prior powers of attorney (and documentation showing why these options are not workable or not consistently honored in emergencies).

Exceptions & Pitfalls

  • Relying on diagnosis alone: Courts usually focus on what the adult can and cannot do. Petitions are stronger when they give concrete examples tied to medical and financial decisions.
  • Over-requesting authority: North Carolina allows limited guardianships when capacity supports it. Asking for the narrowest authority that solves the medical and financial problem can reduce conflict and delay.
  • Missing the evaluation timing window: A multidisciplinary evaluation request must be made in writing and is time-sensitive after service. When it is requested late, the case can become harder to schedule or may proceed without the evaluation.
  • Incomplete family and notice information: The petition requires next-of-kin information. Missing or incorrect addresses can delay service and the hearing.
  • Confusing “medical release” with legal authority: A HIPAA release can allow information sharing, but it does not automatically give authority to consent to treatment or manage money when providers or institutions require a court-appointed decision-maker.

Conclusion

In North Carolina, parents generally obtain adult guardianship by filing a verified incompetency petition and an application for appointment of a guardian with the Clerk of Superior Court in the adult child’s county. Supporting records should show functional limits in understanding, communicating, and managing medical and financial decisions, not just a lifelong diagnosis. If a multidisciplinary evaluation is needed, it generally must be requested in writing within 10 days after service of the petition, and the evaluation can be used at the hearing.

Talk to a Guardianship Attorney

If a family is facing barriers to medical information, consent for treatment, or emergency decision-making for an adult child with lifelong disabilities, a guardianship case may be the next step. Our firm has experienced attorneys who can help evaluate whether full or limited guardianship fits, identify the best evidence to file, and track the court’s deadlines. Call us today at (919) 341-7055.

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.

Category: Guardianship Q&A Series

Author: jpierce

Attorney Jared Pierce is the founder of Pierce Law Group in Raleigh, North Carolina, a firm he established with a dedicated focus on probate administration and estate planning across North Carolina. Born and raised in the Republic of South Africa, Jared moved to Durham with his family in 2001, bringing with him a rich cultural background and a distinctive accent that often serves as a conversation starter.