How to Fill Out and File the PA 1960 Physician Certification Form

The PA 1960 physician certification form is the standardized medical report a physician or licensed psychologist completes to document incapacity in a Pennsylvania guardianship case, and the petitioner files it with the Clerk of the Orphans’ Court Division of the Court of Common Pleas along with the guardianship petition. Under Pennsylvania Orphans’ Court Rule 14.3, a completed report can substitute for live expert testimony at the hearing, provided it is served on opposing counsel at least ten days in advance.¹

Where to Download the Form

The blank form is posted on the Unified Judicial System of Pennsylvania’s website under Orphans’ Court forms.² The PDF is also available as an attachment to the Supreme Court’s rule materials.³ Many county Orphans’ Court clerks keep printed copies at the counter. Download the PDF rather than filling it in through a browser, because some clerks require original ink signatures on paper filings.

Who Fills It Out

Only a licensed physician or licensed psychologist can complete the clinical portions. The petitioner — the person asking the court to appoint a guardian — arranges the evaluation and gets the form into the professional’s hands, but the physician or psychologist is the one who writes the findings and signs. Pennsylvania law permits the court to accept a sworn statement from the physician or psychologist in place of in-person testimony, and the PA 1960 is that sworn statement.⁴

Time the examination so it is close to the anticipated hearing date. No single statewide rule fixes an exact number of days between the exam and the hearing, but courts expect findings to reflect current condition. An evaluation done months before filing invites objections from the court-appointed attorney for the alleged incapacitated person, and can lead the judge to order an independent evaluation, which slows everything down.

What the Physician Documents

The form has two parts: the physician’s credentials and the clinical assessment.

Physician Identification

The examining physician records their full name, professional license number, board certifications, practice address, and contact information, along with the date of the most recent examination. Blank credential fields are one of the most obvious reasons a report gets challenged, so this section should be complete before the form leaves the office.

Clinical Findings and Functional Assessment

The clinical section has to speak to Pennsylvania’s statutory definition. An incapacitated person is an adult whose ability to receive and evaluate information effectively and communicate decisions is impaired to such a significant extent that the person is partially or totally unable to manage financial resources or meet essential requirements for physical health and safety.⁵ Everything the physician writes should tie back to that standard.

Expect to document:

Orientation to person, place, time, and situation.
Memory and cognition, including the severity of any impairment or confusion and the objective tests used to measure it.
Activities of daily living such as grooming, eating, dressing, and mobility.
Complex functional tasks such as managing medications, making informed healthcare decisions, and handling a bank account or bills.
Whether the incapacity is total or partial, which determines whether the court may appoint a plenary or only a limited guardian.
Prognosis: whether the condition is likely to improve, stay stable, or worsen.

The report should also address whether less restrictive alternatives — a power of attorney, a representative payee, or supported decision-making — could adequately protect the person. Pennsylvania courts must prefer less restrictive alternatives over guardianship and, when guardianship is necessary, must prefer limited guardianship over plenary.⁶ A report that concludes “incapacitated” without explaining why existing supports are insufficient leaves a gap the court will notice.

The word choice between “total” and “partial” matters more than it looks. A plenary guardian of the person receives full authority, but the court can only appoint one on a finding of total incapacity. A limited guardian receives only the specific powers matching the areas where the person cannot function. Vague language forces the court to dig deeper, often with an additional evaluation.

Filing the Completed Form

The petitioner files the PA 1960 with the Clerk of the Orphans’ Court Division of the Court of Common Pleas, generally in the county where the alleged incapacitated person lives or is being treated. It goes in with the guardianship petition, which under Orphans’ Court Rule 14.2 must include the names and addresses of the alleged incapacitated person, the petitioner and their relationship, the spouse, parents, presumptive heirs, residential and service providers, and any existing powers of attorney or advance directives.⁷

The petition itself has to describe the functional limitations, the specific areas of incapacity for which guardianship is sought, and the steps taken to find less restrictive alternatives.⁴ The physician’s report supplies the medical evidence supporting those allegations.

Filing fees vary by county. Some counties accept electronic filing under Orphans’ Court Rule 4.7, which lets individual judicial districts implement e-filing through local rules. Philadelphia, for example, runs an Orphans’ Court Electronic Filing System. Other counties still require paper filings at the courthouse. Call your county’s Clerk of the Orphans’ Court to confirm accepted filing methods and the current fee before you go.

The Ten-Day Service Deadline

If the petitioner plans to use the PA 1960 as an expert report in place of live testimony, Rule 14.3 requires serving a copy on the alleged incapacitated person’s counsel and all other counsel of record no later than ten days before the hearing, and filing a certificate of service with the court.¹ Miss this deadline and the court can exclude the report or continue the hearing. Even when the report is properly served, opposing counsel may still call the physician to testify, so the physician should remain available around the hearing date.

This is separate from the 20-day notice the alleged incapacitated person must personally receive of the hearing itself, which is a petition-level requirement rather than something the PA 1960 satisfies.⁴

Common Mistakes That Delay the Case

The physician’s report is often the weak link in a guardianship petition. Watch for these problems:

Conclusory language. “Patient is incapacitated” without specific cognitive deficits, test results, and functional limitations gives the court nothing to work with. The petitioner bears the burden of proving incapacity by clear and convincing evidence, a higher bar than most civil cases.⁴
Silence on less restrictive alternatives. If the report doesn’t touch on this, the petitioner has to fill the gap elsewhere, and the omission can hurt credibility.
Stale examination date. An assessment done months before the hearing raises questions about whether the person’s condition has since changed.
Missing the ten-day service deadline under Rule 14.3, which forces the petitioner to bring the physician in person or ask for a continuance.
Blank credential fields, which cast doubt on the physician’s authority to give an expert opinion.
Vague characterization of the incapacity as neither clearly total nor clearly partial, which forces the court to seek additional evaluations before deciding between limited and plenary guardianship.

HIPAA and Patient Privacy

Physicians sometimes hesitate to complete the PA 1960 because it discloses detailed medical information without patient consent. Federal law permits it. Under 45 CFR § 164.512(e), a physician may disclose protected health information in response to a court order, limited to what the order expressly authorizes.⁸ No separate patient notice or qualified protective order is required.

Even so, the report should stay focused on information relevant to capacity. Unrelated medical history — a past surgery with no bearing on cognition, for example — does not belong on the form. Keeping the record tight protects the patient’s privacy and gives the court a cleaner document to rely on.

1
Legal Information Institute (Cornell Law School). 231 Pa Code r 14.3 – Alternative Proof of Incapacity: Expert Report
2
Unified Judicial System of Pennsylvania. Orphans’ Court Forms
3
Unified Judicial System of Pennsylvania. PA 1960 Physician Certification Form
4
Pennsylvania General Assembly. 20 Pennsylvania Consolidated Statutes 5511 – Petition and Hearing; Independent Evaluation
5
Pennsylvania General Assembly. 20 Pennsylvania Code 5501 – Meaning of Incapacitated Person
6
Pennsylvania General Assembly. 20 Pennsylvania Consolidated Statutes 5512.1 – Determination of Incapacity and Appointment of Guardian
7
Pennsylvania Code and Bulletin. 231 Pa Code Rule 14.2 – Petition for Adjudication of Incapacity and Appointment of a Guardian of the Person or Estate of an Incapacitated Person
8
eCFR. 45 CFR 164.512 – Uses and Disclosures for Which an Authorization or Opportunity to Agree or Object Is Not Required