Dec302025
Guardianship Q&A Series

What medical records and paperwork do I need to start a guardianship? – North Carolina

Short Answer

In North Carolina, starting a guardianship usually requires (1) paperwork filed with the Clerk of Superior Court and (2) medical or clinical information that shows why the person cannot manage some or all decisions. The exact medical records vary by situation, but most cases go smoother with recent records that explain diagnosis, functional limits, and decision-making capacity. The court can also order an evaluation if current information is not available or is not enough.

Understanding the Problem

In North Carolina, what medical records and paperwork must be gathered to ask the Clerk of Superior Court to appoint a guardian for an adult with limited decision-making ability, and how much documentation is needed to support a limited (least restrictive) guardianship instead of a full guardianship?

Apply the Law

Guardianship cases in North Carolina are handled through the Clerk of Superior Court. To get a guardian appointed for an adult, the case generally involves an incompetency determination and then an application to appoint the right type of guardian (guardian of the person, guardian of the estate, or a general guardian). The clerk can consider testimony and written materials and may order an evaluation if current information is missing or not sufficient. The clerk can also tailor the guardianship and order a limited guardianship when the person has some capacity and only needs help in specific areas.

Key Requirements

  • Case-starting paperwork: A filed application that identifies the person, next of kin/other interested people, and whether the request is for a guardian of the person, estate, or both, plus a basic picture of assets and liabilities.
  • Capacity evidence: Medical or clinical information that explains the condition and, more importantly, how it affects the ability to make or communicate responsible decisions (so the clerk can decide the nature and extent of any guardianship).
  • Scope and suitability: Information that supports the least restrictive option (limited guardianship if appropriate) and shows who can most suitably serve as guardian, including the person’s needs and finances.

What the Statutes Say

Analysis

Apply the Rule to the Facts: The situation involves a child with autism approaching adulthood and a concern about continuing to help with healthcare, banking, and daily decisions once privacy rules and adulthood limit parental access. To support a least restrictive request, the most useful records are those that describe functional decision-making limits (not just a diagnosis) and identify which decisions the young adult can and cannot handle. Because the clerk can order a limited guardianship, paperwork should be organized to show the specific areas where help is needed (for example, medical decision-making and benefits management) and the areas where independence can remain.

Process & Timing

  1. Who files: A parent, other interested person, or other qualified applicant. Where: The Clerk of Superior Court in the county where the respondent lives in North Carolina. What: The guardianship application identifying the respondent, next of kin/interested persons, the requested type of guardian (person, estate, or general), and a general statement of assets and liabilities; plus supporting medical/capacity documentation. When: Often filed shortly before or after the child turns 18; there is not a single universal “grace period,” so planning ahead matters when decision-making access will change at adulthood.
  2. Evidence gathering: The clerk may accept written reports, affidavits, and other documents and can require more information to understand the needed scope. If current medical information is not available or is not enough, the clerk can order an evaluation.
  3. Hearing and appointment: The clerk holds a hearing to decide the nature and extent of the guardianship (including whether a limited guardianship fits) and who should serve, considering needs and finances. If appointed, the guardian receives court authority documents that third parties often require before sharing information or allowing decisions.

Exceptions & Pitfalls

  • Diagnosis is not enough: A label like autism or dementia usually does not answer the court’s core question. Records should address functional capacity—what decisions can be understood, communicated, and carried out—and what support is needed.
  • Outdated or thin records: Old records may not reflect current functioning. If the file does not show present-day limits, the clerk may require additional evidence or order an evaluation, which can slow the case.
  • Least restrictive mismatch: Requesting a full guardianship when the evidence supports only limited help can create avoidable conflict and delay. Organizing records by decision area (medical, money, living arrangements) helps match the request to the need.
  • HIPAA and releases: Even before guardianship, providers may share information if proper releases are signed. If the adult cannot or will not sign releases, the case may need stronger medical documentation and a clear plan for the scope of authority requested.
  • Mixing two people into one case: A guardianship for a young adult and a guardianship for a parent with dementia are separate legal matters. Each person generally requires separate filings and separate supporting medical documentation.
  • VA-related paperwork is its own lane: If the issue involves VA-related funds and an incompetency rating under VA processes, additional petition details may apply. That does not automatically replace North Carolina’s guardianship process for broader decision-making.

Conclusion

In North Carolina, starting a guardianship typically requires filing an application with the Clerk of Superior Court and providing medical or clinical information that shows how the person’s condition affects decision-making and what scope of help is needed. The clerk can order a limited guardianship when appropriate and can require an evaluation if current information is not available. The most important next step is to file the guardianship application with the Clerk of Superior Court in the county of residence with recent records that address functional capacity.

Talk to a Guardianship Attorney

If a family is dealing with a child turning 18 with limited decision-making ability or an older adult with dementia and needs to understand what records, filings, and timelines apply in North Carolina, our firm has experienced attorneys who can help explain options and next steps. 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.