What medical letters or records do I need to prove my adult child isn’t able to make medical and financial decisions? – North Carolina

Short Answer

In North Carolina, a guardianship case is proven with evidence that an adult lacks enough capacity to manage personal affairs (medical decisions) and/or property (money) or to communicate important decisions. The most useful records usually include a treating provider’s written opinion describing diagnosis, functional limits, and how those limits affect decision-making, plus supporting records (evaluations, hospital/clinic notes, and benefits-related determinations). The Clerk of Superior Court decides what is persuasive, so the goal is clear, current, function-focused documentation rather than a single “magic” letter.

Understanding the Problem

In North Carolina guardianship, the key question is: can an adult child make and communicate informed decisions about personal needs (like health care and safety) and financial matters (like paying bills and managing benefits)? The issue usually comes up when a parent or caregiver needs legal authority to help with medical decisions, manage money, or both. The decision point is whether the evidence shows limits that rise to the level of legal incompetency for a guardian appointment, rather than ordinary difficulty or immaturity.

Apply the Law

In North Carolina, a general guardianship involves asking the Clerk of Superior Court to find an adult “incompetent” under Chapter 35A and then appoint a guardian. Medical records and letters are not required in one specific format statewide, but they are often central evidence because they help show (1) the cause and nature of the condition, (2) how it affects daily functioning, and (3) whether the person can manage personal affairs and/or property or communicate decisions. The most persuasive documentation ties medical findings to real-world decision-making problems (for example, inability to understand risks, follow treatment, manage funds, or keep safe).

Key Requirements

Clinical basis and prognosis: Records should identify the condition causing the limitations and describe whether the limits are temporary, long-term, or expected to change.
Functional impact on decision-making: The documentation should connect symptoms to specific problems with understanding, reasoning, judgment, or communicating choices about health care and finances.
Scope (person, estate, or both): Evidence should address whether the adult child needs help with medical/personal decisions, financial decisions, or both, because that affects whether the Clerk appoints a guardian of the person, guardian of the estate, or a general guardian.

What the Statutes Say

N.C. Gen. Stat. § 35A-1206 (Letters of appointment) – After appointment and qualification, the Clerk issues letters showing whether the guardian is for the person, the estate, or both.
N.C. Gen. Stat. § 35A-1208 (Authority for health care decisions) – A guardian of the person or general guardian may seek an order affecting a health care agent’s authority in certain situations.
N.C. Gen. Stat. § 34-7 (Certificate as evidence for certain federal benefits) – A qualifying certificate that a person has been rated incompetent for certain benefits can serve as prima facie evidence supporting the need for a guardian in a guardianship petition.
N.C. Gen. Stat. § 35A-1375 (Written physician determination for standby guardianship) – In the standby guardianship context, a physician’s written determination should describe cause, nature, extent, and probable duration; this is a useful model for what courts often find helpful in capacity-related medical documentation.
N.C. Gen. Stat. § 131E-118 (Transfer of management responsibilities) – A legal guardian (or other authorized representative) may sign certain documents and manage information in health care facility settings when properly authorized.

Analysis

Apply the Rule to the Facts: The facts describe significant functional limitations affecting money management, hygiene and household tasks, and safety/independence, with medical providers indicating diminished capacity. Records that will matter most are those that translate the diagnosis and symptoms into decision-making limits—such as inability to understand consequences, follow through on care, recognize unsafe situations, or manage funds and benefits. Because the request is for a general guardianship, the documentation should address both personal/medical decision-making and financial decision-making, not just one area.

Process & Timing

Who files: The parent or other interested person. Where: The Clerk of Superior Court (estate/guardianship division) in the North Carolina county where the adult child resides or is present. What: A petition to adjudicate incompetence and appoint a guardian, plus supporting documentation (including provider records/letters). When: File as soon as decision-making authority is needed; hearing dates and notice timelines vary by county.
Evidence gathering: Request records from treating providers (primary care, psychiatry, neurology, psychology, therapy) and any recent evaluations. Ask providers for a function-focused letter that explains how the condition affects the ability to make and communicate medical and financial decisions.
Hearing and appointment: The Clerk reviews testimony and documents, decides incompetency, and—if appropriate—appoints the guardian. After qualification, the Clerk issues letters of appointment that third parties often require before accepting a guardian’s authority.

Exceptions & Pitfalls

“Diagnosis-only” letters: A letter that lists diagnoses but does not explain functional limits and decision-making impact often carries less weight than a letter that ties symptoms to specific risks and impaired judgment.
Outdated records: Older records may not reflect current functioning. A recent assessment (or an updated treating-provider statement) usually helps, especially when capacity fluctuates.
Overbroad conclusions: Providers sometimes write “cannot make any decisions.” The Clerk often needs a clearer explanation of what decisions the adult child cannot manage and why, and whether any abilities remain.
Mismatch between requested guardianship and proof: Seeking a general guardian (person and estate) while only submitting records about medical issues (or only finances) can create avoidable gaps.
Benefits paperwork confusion: A representative payee process for disability-related benefits is separate from guardianship. Evidence used for benefits may help, but it does not automatically prove the legal standard for guardianship in every case.
Health care agent and advance directives: If the adult child previously signed a health care power of attorney or similar document, the guardianship case may need to address how that authority interacts with a guardian’s authority.

What to Ask Medical Providers to Include (Practical Checklist)

Provider relationship: How long the provider has treated the adult child and in what setting (clinic, hospital, therapy).
Diagnosis and cause: The condition(s) causing the limitations and any relevant history.
Capacity-related findings: Observations about understanding, memory, judgment, impulse control, ability to weigh risks/benefits, and ability to communicate choices.
Functional examples: Concrete examples of problems managing medications, attending appointments, recognizing unsafe situations, handling money, paying bills, avoiding exploitation, or maintaining basic self-care.
Extent and expected duration: Whether the limitations are likely to improve, remain stable, or worsen.
Recommended supports: Whether less restrictive supports (supported decision-making, payee, POA) are workable, or why they are not workable given the adult child’s functioning.

Conclusion

To prove an adult child cannot make medical and financial decisions in North Carolina, the most helpful evidence is current, function-focused medical documentation that explains the condition, how it limits judgment and communication, and whether the limits affect personal decisions, financial decisions, or both. The case is filed with the Clerk of Superior Court, and the Clerk decides whether to appoint a guardian and what type. The practical next step is to request treating-provider records and a written capacity-focused letter and file the guardianship petition with the Clerk as soon as possible.

Talk to a Guardianship Attorney

If a family is dealing with an adult child who cannot safely manage medical care or money, a guardianship case often turns on getting the right records and presenting them clearly to the Clerk of Superior Court. Our firm has experienced attorneys who can help explain options, prepare the filing, and track timelines. 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.