Feb52026
Guardianship Q&A Series

What kind of proof do I need from doctors or the hospital to show the person can’t make decisions? – North Carolina

Short Answer

In North Carolina, the court process for guardianship focuses on whether the adult lacks capacity to manage affairs or make or communicate important decisions. Helpful proof usually includes recent medical records and a written statement from a treating provider describing the diagnosis, functional limits, and why the person cannot make or communicate key decisions right now. For an emergency (interim) guardianship request, the filing must also show an immediate risk of harm and the need for a guardian before the full incompetency hearing.

Understanding the Problem

In a North Carolina adult guardianship case, the key question is what proof shows that a hospitalized adult sibling cannot make or communicate important decisions well enough to safely handle personal, medical, or financial matters. The issue usually comes up when a family member needs authority quickly to consent to care, coordinate discharge planning, or protect the person from immediate harm while the longer, permanent guardianship process moves forward.

Apply the Law

North Carolina uses a court process (handled through the Clerk of Superior Court) to decide whether an adult is an “incompetent adult.” The legal focus is not whether the person is sick or hospitalized, but whether the person lacks sufficient capacity to manage affairs or to make or communicate important decisions, and whether less restrictive alternatives would work. For an emergency request (called an interim guardian), the court also looks for facts showing reasonable cause to believe incompetence exists plus an imminent or foreseeable risk of harm that requires immediate intervention.

Key Requirements

  • Capacity problem tied to real decisions: Proof should connect the medical condition to an inability to manage affairs or make/communicate important decisions (not just a diagnosis label).
  • Current, specific clinical facts: Proof is stronger when it is recent and describes functional limits (orientation, understanding, judgment, ability to communicate choices, consistency over time), not conclusions alone.
  • Why a court order is needed now: For emergency/interim relief, proof should also show immediate risk of harm to physical well-being or the estate and why waiting for the full hearing is not safe.

What the Statutes Say

Analysis

Apply the Rule to the Facts: Here, the adult sibling is hospitalized and has been deemed unable to make decisions. The most useful proof will be hospital documentation and treating-provider input that explains (1) what condition or event caused the loss of capacity, (2) what decisions the sibling cannot understand, appreciate, or communicate, and (3) whether the problem is temporary, fluctuating, or expected to last. Because an emergency/interim guardianship is being considered, the proof should also describe the immediate decision that must be made (for example, consent to a procedure or a safe discharge plan) and the risk of harm if no one has legal authority to act.

Process & Timing

  1. Who files: A family member (or other interested person) files a verified petition to adjudicate incompetence, and may also file a verified motion for an interim guardian. Where: The Office of the Clerk of Superior Court in the county where the respondent resides (and in some situations where the respondent is physically present). What: The petition must include facts showing incompetence and must address less restrictive alternatives. When: The interim hearing must be held as soon as possible, but no later than 15 days after the motion has been served on the respondent.
  2. Gather medical proof: Request the most recent hospital records that document decision-making capacity (for example, physician progress notes, psychiatry consult notes, neurology notes, discharge planning notes, and any formal capacity assessment). Ask a treating provider for a short written statement that focuses on functional capacity and the need for a decision-maker, rather than only a diagnosis.
  3. Present evidence at the hearings: For interim guardianship, the clerk decides whether there is reasonable cause to believe incompetence exists and whether immediate intervention is needed. For permanent guardianship, the case proceeds through the incompetency adjudication process and then (if incompetence is found) appointment of the appropriate type of guardian.

Exceptions & Pitfalls

  • “Diagnosis” is not the same as “incapacity”: A letter that only says “unable to make decisions” without explaining what the person cannot understand or communicate is often less persuasive than records describing specific functional limits.
  • Fluctuating capacity: Hospital delirium, medication effects, or acute illness can cause capacity to change day-to-day. Proof should address whether the person can make decisions consistently and whether the impairment is expected to improve.
  • Less restrictive alternatives: North Carolina requires the petition to identify alternatives considered (like powers of attorney, supported decision making, or other arrangements) and why they are not enough. Ignoring this requirement can slow the case down. For more background, see recent medical records and how courts often view them.
  • Access to records (HIPAA): Hospitals may limit release without proper authority. A court process may be needed to obtain records quickly, so it helps to request records early and ask the care team what documentation they can provide for court purposes.
  • Emergency standard is higher: An interim guardian request must show immediate risk of harm and the need for immediate intervention, not just that a guardianship would be helpful.

Conclusion

In North Carolina, proof that an adult “can’t make decisions” should show a current, functional loss of capacity to manage affairs or to make or communicate important decisions, not just a diagnosis. Hospital records and a treating provider’s written statement that explains the condition, the decision-making limits, and expected duration are often the most helpful. For emergency (interim) guardianship, the filing must also show immediate risk of harm and the need for action before the full hearing. The next step is to file a verified incompetency petition (and, if needed, a verified interim-guardian motion) with the Clerk of Superior Court.

Talk to a Guardianship Attorney

If a hospitalized adult sibling cannot make or communicate important decisions and an emergency guardianship may be needed, our firm has experienced attorneys who can help explain what proof is most persuasive and how quickly the court can act. Call us today at [CONTACT NUMBER].

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: Pierce Law

Pierce Law Group is a North Carolina law firm focused on probate administration, real estate partition matters, and surplus funds claims across North Carolina. We know these situations often come with stress, family dynamics, and time-sensitive decisions—so we prioritize clear communication, steady guidance, and a practical plan from day one. Our goal is to make a complicated process feel manageable, while protecting what matters most to you.