"Advance Directive for Health Care" - Maryland

The Maryland Advance Directive for Health Care is a set of instructions about preferred medical care that takes effect when a patient becomes unable to make decisions. In addition to listing preferences for medical care, the form provides individuals with the option of appointing a health care proxy. A health care proxy - otherwise known as a health care agent or surrogate - is a person who has the authority to make health-related decisions on another person's behalf.

The document was prepared by the Office of the Maryland Attorney General in October 2017 and can be downloaded through the link below. The Maryland Advance Directive is regulated by Title 5 (Death) Subtitle 6 (Health Care Decisions Act) of the Maryland Code. The document must be signed by two (2) witnesses. Any competent individual - including medical facility employees, nurses, and physicians - may serve as a witness to the Directive.

There is a difference between this form and a Living Will in Maryland. A Living Will is a specific type of an Advance Directive for Health Care that becomes effective only in the event of a terminal illness.

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Download "Advance Directive for Health Care" - Maryland

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M
A
D
:
ARYLAND
DVANCE
IRECTIVE
P
F
H
C
D
LANNING FOR
UTURE
EALTH
ARE
ECISIONS
S
M
TATE OF
ARYLAND
O
A
G
FFICE OF THE
TTORNEY
ENERAL
Brian E. Frosh
Attorney General
October 2017
M
A
D
:
ARYLAND
DVANCE
IRECTIVE
P
F
H
C
D
LANNING FOR
UTURE
EALTH
ARE
ECISIONS
S
M
TATE OF
ARYLAND
O
A
G
FFICE OF THE
TTORNEY
ENERAL
Brian E. Frosh
Attorney General
October 2017
Dear Fellow Marylander:
I am pleased to send you an advance directive form that you can use to plan
for future health care decisions. The form is optional; you can use it if you want or use
others, which are just as valid legally. If you have any legal questions about your
personal situation, you should consult your own lawyer. If you decide to make an
advance directive, be sure to talk about it with those close to you. The conversation is
just as important as the document. Give copies to family members or friends and
your doctor. Also make sure that, if you go into a hospital, you bring a copy. Please
do not return completed forms to this office.
Life-threatening illness is a difficult subject to deal with. If you plan now,
however, your choices can be respected and you can relieve at least some of the
burden from your loved ones in the future. You may also use another enclosed form
to make an organ donation or plan for arrangements after death.
Here is some related, important information:
If you want information about Do Not Resuscitate (DNR) Orders, please
visit the website
http://marylandmolst.org
or contact the Maryland
Institute for Emergency Medical Services Systems directly at (410) 706-
4367. A Medical Orders for Life-Sustaining Treatment (MOLST) form
contains medical orders regarding cardiopulmonary resuscitation (CPR)
and other medical orders regarding life-sustaining treatments. A
physician or nurse practitioner may use a MOLST form to instruct
emergency medical personnel (911 responders) to provide comfort care
instead of resuscitation. The MOLST form can be found on the Internet
at: http://marylandmolst.org. From that page, click on “MOLST Form.”
The Maryland Department of Health makes available an advance
directive focused on preferences about mental health treatment. This
can be found on the Internet at:
https://bha.health.maryland.gov/Pages/Forms.aspx. From that page,
under “Forms,” click on “Advance Directive for Mental Health
Treatment.”
I hope that this information is helpful to you. I regret that overwhelming
demand limits us to supplying one set of forms to each requester. But please feel
free to make as many copies as you wish. Additional information about advance
directives can be found on the Internet at:
http://www.oag.state.md.us/healthpol/advancedirectives.htm.
Brian E. Frosh
Attorney General
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HEALTH CARE PLANNING
USING ADVANCE DIRECTIVES
Optional Form Included
Your Right To Decide
Adults can decide for themselves
This optional form can be filled out
whether they want medical treatment.
without going to a lawyer. But if there is
This right to decide - to say yes or no to
anything you do not understand about the
proposed
treatment
-
applies
to
law or your rights, you might want to talk
treatments that extend life, like a
with a lawyer. You can also ask your
breathing machine or a feeding tube.
doctor to explain the medical issues,
Tragically, accident or illness can take
including the potential benefits or risks to
away a person's ability to make health
you of various options. You should tell
care decisions. But decisions still have to
your doctor that you made an advance
be made. If you cannot do so, someone
directive and give your doctor a copy,
else will. These decisions should reflect
along with others who could be involved
your own values and priorities.
in making these decisions for you in the
future.
A Maryland law called the Health Care
Decisions Act says that you can do health
In Part III of the form, you need two
care
planning
through
“advance
witnesses to your signature. Nearly any
directives.” An advance directive can be
adult can be a witness. If you name a
used to name a health care agent. This is
health care agent, though, that person
someone you trust to make health care
may not be a witness. Also, one of the
decisions for you. An advance directive
witnesses must be a person who would
can also be used to say what your
not financially benefit by your death or
preferences are about treatments that
handle your estate. You do not need to
might be used to sustain your life.
have the form notarized.
The State offers a form to do this
This
pamphlet
also
contains
a
planning, included with this pamphlet.
separate form called “After My Death.”
The form as a whole is called “Maryland
Like the advance directive, using it is
Advance Directive: Planning for Future
optional. This form has four parts to it:
Health Care Decisions.” It has three parts
Part I, Organ Donation; Part II, Donation
to it: Part I, Selection of Health Care
of Body; Part III, Disposition of Body and
Agent; Part II, Treatment Preferences
Funeral Arrangements; and Part IV,
(“Living Will”); and Part III, Signature and
Signature and Witnesses.
Witnesses. This pamphlet will explain
each part.
Once you make an advance directive,
it remains in effect unless you revoke it.
The advance directive is meant to
It does not expire, and neither your family
reflect
your
preferences.
You
may
nor anyone except you can change it. You
complete all of it, or only part, and you
should review what you've done once in a
may change the wording. You are not
while. Things might change in your life,
required by law to use these forms.
or your attitudes might change. You are
Different forms, written the way you
free to amend or revoke an advance
want, may also be used. For example, one
directive at any time, as long as you still
widely praised form, called Five Wishes, is
have decision-making capacity. Tell your
available (for a small fee) from the
doctor and anyone else who has a copy of
nonprofit
organization
Aging
With
your advance directive if you amend it or
Dignity. You can get information about
revoke it.
that document from the Internet at
www.agingwithdignity.org
or write to:
If you already have a prior Maryland
Aging with Dignity, P.O. Box 1661,
advance directive, living will, or a durable
Tallahassee, FL 32302.
power of attorney for health care, that
-iii-
document is still valid. Also, if you made
The form included with this pamphlet
an advance directive in another state, it is
does not give anyone power to handle your
valid in Maryland. You might want to
money. We do not have a standard form to
review these documents to see if you
send. Talk to your lawyer about planning
prefer to make a new advance directive
for financial issues in case of incapacity.
instead.
Part II of the Advance Directive:
Part I of the Advance Directive:
Treatment Preferences
Selection of Health Care Agent
(“Living Will”)
You can name anyone you want (except,
You have the right to use an advance
in general, someone who works for a health
directive to say what you want about future
care facility where you are receiving care) to
life-sustaining treatment issues. You can do
be your health care agent.
To name a
this in Part II of the form. If you both name
health care agent, use Part I of the
a health care agent and make decisions
advance directive form.
(Some people
about treatment in an advance directive, it’s
refer to this kind of advance directive as a
important that you say (in Part II, paragraph
“durable power of attorney for health care.”)
G) whether you want your agent to be
Your agent will speak for you and make
strictly bound by whatever treatment
decisions based on what you would want
decisions you make.
done or your best interests. You decide how
much power your agent will have to make
Part II is a living will. It lets you decide
health care decisions. You can also decide
about life-sustaining procedures in three
when you want your agent to have this
situations: when death from a terminal
power ─ right away, or only after a doctor
condition
is
imminent
despite
the
says that you are not able to decide for
application of life-sustaining procedures; a
yourself.
condition of permanent unconsciousness
called a persistent vegetative state; and end-
You can pick a family member as a
stage condition, which is an advanced,
health care agent, but you don't have to.
progressive,
and
incurable
condition
Remember, your agent will have the power
resulting in complete physical dependency.
to make important treatment decisions,
One example of end-stage condition could
even if other people close to you might urge
be advanced Alzheimer's disease.
a different decision. Choose the person best
qualified to be your health care agent. Also,
consider picking one or two back-up agents,
in case your first choice isn’t available when
needed.
Be sure to inform your chosen
person and make sure that he or she
understands what’s most important to you.
When the time comes for decisions, your
health care agent should follow your written
directions.
We have a helpful booklet that you can
give to your health care agent. It is called
“Making Medical Decisions for Someone Else:
A Maryland Handbook.” You or your agent
can get a copy on the Internet at:
http://www.marylandattorneygeneral.gov/
Health%20Policy%20Documents/ProxyHan
dbook.pdf. You can request a copy by calling
410-576-7000.
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FREQUENTLY ASKED QUESTIONS ABOUT
ADVANCE DIRECTIVES IN MARYLAND
1.
Must I use any particular form?
It depends on what you want to do. If all you
want to do is name a health care agent, just fill out
No. An optional form is provided, but you
Parts I and III, and talk to the person about how
may change it or use a different form altogether. Of
they should decide issues for you. If all you want to
course, no health care provider may deny you care
do is give treatment instructions, fill out Parts II
simply because you decided not to fill out a form.
and III. If you want to do both, fill out all three
parts.
2.
Who can be picked as a health care agent?
8.
Are these forms valid in another state?
Anyone who is 18 or older except, in general,
an owner, operator, or employee of a health care
It depends on the law of the other state. Most
facility where a patient is receiving care.
state laws recognize advance directives made
somewhere else.
3.
Who can witness an advance directive?
9.
How can I get advance directive forms for
Two witnesses are needed. Generally, any
another state?
competent adult can be a witness, including your
doctor or other health care provider (but be aware
Contact Caring Connections (NHPCO) at 1-
that some facilities have a policy against their
800-658-8898
or
on
the
Internet
at:
employees serving as witnesses). If you name a
http://www.caringinfo.org.
health care agent, that person cannot be a witness
for your advance directive. Also, one of the two
10. To whom should I give copies of my
witnesses must be someone who (i) will not
advance directive?
receive money or property from your estate and
(ii) is not the one you have named to handle your
Give copies to your doctor, your health care
estate after your death.
agent and backup agent(s), hospital or nursing
home if you will be staying there, and family
4.
Do the forms have to be notarized?
members or friends who should know of your
wishes. Consider carrying a card in your wallet
No, but if you travel frequently to another
saying you have an advance directive and who to
state, check with a knowledgeable lawyer to see if
contact.
that state requires notarization.
11. Does the federal law on medical records
5.
Do any of these documents deal with
privacy (HIPAA) require special language
financial matters?
about my health care agent?
No. If you want to plan for how financial
Special language is not required, but it is
matters can be handled if you lose capacity, talk
prudent. Language about HIPAA has been
with your lawyer.
incorporated into the form.
6.
When using these forms to make a decision,
12. Can my health care agent or my family
how do I show the choices that I have
decide treatment issues differently from
made?
what I wrote?
Write your initials next to the statement that
It depends on how much flexibility you want
says what you want. Don't use checkmarks or X's.
to give. Some people want to give family members
If you want, you can also draw lines all the way
or others flexibility in applying the living will.
through other statements that do not say what you
Other people want it followed very strictly. Say
want.
what you want in Part II, Paragraph G.
7.
Should I fill out both Parts I and II
13. Is an advance directive the same as a
of the advance directive form?
“Patient’s Plan of Care”, “Instructions on
Current
Life-Sustaining
Treatment
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What Is a Maryland Advance Directive?

Advance Directives are legally binding documents that outline an individual's wishes regarding life support, resuscitation and other interventions for both their health care team and family members. The paperwork includes two parts in total - a Living Will and a Medical Power of Attorney.

A Living Will is a legal document that intends to ensure and specify an individual's end-of-life wishes regarding health care and medical treatment in the event of their permanent incapacity. A Medical Power of Attorney - otherwise called a Durable Power of Attorney for Health Care - is a form that elects an agent to make medical decisions on the behalf of the individual signing the document.

How to Write an Advance Directive in Maryland?

Making an Advance Care Directive in Maryland usually features the following steps:

STEP 1 - Elect a health care proxy - or agent - to make medical decisions on your behalf. Be sure to choose a person willing to respect and follow your wishes

STEP 2 - Write down your wishes regarding any limitations in medical treatment. Specify whether you agree to be on a dialysis machine, extracorporeal membrane oxygenation (ECMO) machine, receive CPR or take antibiotics to treat infections

STEP 3 - Make decisions regarding the possibility of organ and tissue donation and state your preferences regarding burial and the disposition of remains.

STEP 4 - Keep the original signed and certified form, hand a copy out to your agent and ask your doctor to keep a copy of your document with your medical records.