6-10 Determination of incapacity, Guardianship Forms (Family Court Act Article 6; S.C.P.A.; Social Services Law Section 384-b), Subchapter A. Forms Authorized by Section 205.7, Chapter IV. Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7), Subtitle D. Forms, TITLE 22. Judiciary, New York Codes Rules Regulations

New York Codes Rules Regulations (Last Updated: March 27,2024)

Chapter IV. Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7)

Subchapter A. Forms Authorized by Section 205.7

Guardianship Forms (Family Court Act Article 6; S.C.P.A.; Social Services Law Section 384-b)

6-10 Determination of incapacity

Secs. 661 F.C.A.;

Form 6-10

1726 S.C.P.A.

(Determination

of Incapacity)

9/92

FAMILY COURT OF THE STATE OF NEW YORK

COUNTY OF __

________________

Proceedings for the Appointment of

Docket No. __ a Standby Guardian of the Person of

DETERMINATION

_______

a Minor

OF INCAPACITY

________________

Pursuant to Section 1726 of the Surrogate's Court Procedure Act, I, [name] __, state that:

1. I am a physician who is:

(the attending physician, as that term is defined in Section 1726 of the S.C.P.A., to [name]

, the petitioner in the above-captioned proceeding.)

(acting on behalf of [name] __, who is the attending physician, as that term is defined in Section 1726 of the S.C.P.A; to [name] __, the petitioner, the Petitioner in the above- captioned proceeding.) (familiar with the medical condition of [name] __, the petitioner in the above- captioned proceeding.)

2. I have determined, based on a reasonable degree of medical certainty, that petitioner is incapacitated, in that (he) (she) suffers from a chronic and substantial inability, as a result of mental impairment, to understand the nature and consequences of decisions concerning the care of (his) (her) minor child(ren), and is consequently unable to care for said child(ren).

3. In my professional opinion, the cause and nature of the petitioner's incapacity, as well as its extent and probable duration, are:

4. Upon information and belief, petitioner wishes the Court to name __ as Standby Guardian of (his) (her) minor child(ren); accordingly, I have provided a copy of this Determination of Incapacity to the Standby Guardian.

Signature

License No.

Hospital:

I, [name] _______, acknowledge receipt of the foregoing Determination of Incapacity.

Signature of Standby Guardian

Dated: ______