Maryland Advance Health Care Directive(Living Will)

The Maryland advance health care directive(living will) is a legal document that would be utilized by an individual (Principal) so that, in the event of illness, disease or even an accident that may leave the Principal in a position of being unable to communicate their wishes for health care, in an end of life scenario, they will have legally recorded how they would like their medical treatments, additions and/or withdrawals handled by medical professionals. This document will also provide the opportunity for the Principal to assign an Agent, who may speak on behalf of the Principal if the individual would prefer. Once completed, this document will require witness. As long as the Principal is of sound mind, they may make changes or revoke the document as they wish.

Laws – HG §5-601, et seq. Health Care Decisions Act

How to Write

Step 1 – Download this document and begin by establishing the Principal. Enter:

  • Printed the Principal’s name in the first line of the form
  • Date of birth in mm/dd/yyyy format
  • It is important the the Principal review the next four paragraphs in this section

Step 2 – Selection of Health Care Agent – Submit the following information regarding the selected agent:

  • Agent’s full name
  • Complete Address
  • Home and Cell telephone numbers

In the event, for any reason the initial agent is unable to continue to serve, the Principal may select up to two alternates and enter the same information for each respectively. This step is optional –

  • Review the following sections:
  • Powers and Rights of Health Care Agent (The Principal has the option (not required) of providing limits and/or conditions by entering the information into the box provided)
  • How my Agent is to Decide Specific Issues
  • People My Agent Should Consult (optional) – If the Principal would like others to consult their agent, enter their names and telephone contact numbers into the lines provided
  • In Case of Pregnancy (Optional, for women of child-bearing years only; the document is still valid if left blank)
  • Access to my Health Information – Federal Privacy Law (HIPAA) Authorization
  • Effectiveness of this Part – (The Principal must review the statements and initial their personal choice)

Step 3 – Treatment Preferences – Review the information contained in this section as follows:

  • Statement of Goals and Values – (Optional)
  • Preference in Case of Terminal Condition – (Review the three statements provided and initial the one that best fits the Principal’s wishes)
  • Preference in Case of Persistent Vegetative State – (Initial only one of the statements that would best reflect the Principal’s wishes, under these conditions)
  • Preference in Case of End-Stage Condition – ( Enter the Principal’s initials next to only one of the statements provided)
  • Pain Relief
  • In Case of Pregnancy (Optional)
  • Effect of Stated Preferences – ( Initial only one of the provided preferences)

Step 4 – Signatures and Witnesses -The Principal must carefully review the first paragraph in this section, if in agreement:

  • Submit the Principal’s Signature
  • Date the signature in mm/dd/yyyy format

Witnesses – The Agent(s) are not eligible to sign this document as witness –

  • Witnesses must read the witness statement and enter the following (respectively)
  • Witnesses Signatures
  • Date of signature in mm/dd/yyyy format
  • Telephone numbers

Step 5 – After Death – This section is completely optional, the Principal may complete any or none of this section. If the Principal would like to consider any of these titles, read through the following (none of this is a requirement):

  • Organ Donation
  • Donation of Body
  • Disposition of Body and Funeral Arrangements

Should the Principal participate in any of these options, be certain to provide the Principal’s and witnesses signatures at the end of the section

 

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