Maryland Living Will Template
This Maryland Living Will is governed by the Maryland Health Care Decisions Act. It is a legal document that allows individuals to outline their preferences for medical treatment in the event that they become unable to communicate their wishes.
Please complete all sections of this form to ensure your healthcare preferences are understood and respected.
Personal Information
- Full Name: ______________________________________
- Address: _________________________________________
- City: _____________, State: MD, Zip: ____________
- Date of Birth: ___________________________________
- Telephone Number: _______________________________
Designation of Health Care Agent
I, _________________ [your name], appoint the following person as my Health Care Agent to make health care decisions for me if a time comes when I am unable to make health care decisions for myself.
- Agent's Full Name: ______________________________________
- Agent's Address: ________________________________________
- Agent's City: _____________, State: ____, Zip: ___________
- Agent's Telephone Number: _______________________________
- Relationship to me: _____________________________________
General Instructions for Health Care
I give the following instructions regarding my health care to be followed if I become unable to participate in my own health care decisions.
- Preference in the event of a terminal condition: ______________________________________________________
- Preference in the event of a persistent vegetative state: _______________________________________________
- Preferences regarding artificial nutrition and hydration: _______________________________________________
- Additional instructions: ____________________________________________________________________________
Signature
By signing below, I indicate that I am emotionally and mentally competent to make this Living Will, and I understand its contents completely.
- Signature: _______________________________ Date: ____________
Printed Name: _______________________________
Witnesses
This document must be witnessed by two individuals who are not the spouse, children, heirs, or beneficiaries of the person creating the Living Will.
- Witness 1 Signature: _______________________________ Date: ____________
- Witness 1 Printed Name: _____________________________
- Witness 2 Signature: _______________________________ Date: ____________
- Witness 2 Printed Name: _____________________________
Note: This document does not need to be notarized in Maryland. However, retaining a copy in a safe but accessible location and providing your health care agent, if one is designated, with a copy is recommended.