Fillable Medical Power of Attorney Document for Maryland State

The Maryland Medical Power of Attorney form is a legal document that allows an individual, referred to as the principal, to appoint someone they trust, known as the agent, to make healthcare decisions on their behalf should they become unable to do so. This form is an essential part of healthcare planning, ensuring that the principal's wishes are honored even when they can't communicate their desires themselves. To secure your healthcare decisions for the future, consider filling out this form by clicking the button below.

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Imagine a situation where someone can't make decisions about their medical treatment due to an illness or injury. This is where the Maryland Medical Power of Attorney form becomes a critical legal document. It allows individuals to appoint a trusted person, known as an agent, to make healthcare decisions on their behalf if they are unable to do so themselves. The form covers a wide range of decisions, from choosing medical treatments to making end-of-life care decisions, depending on one's personal, moral, or religious beliefs. The power of this document lies in its ability to ensure that healthcare providers follow the patient's wishes, even when they can't communicate them directly. With the Maryland Medical Power of Attorney form, individuals have the peace of mind knowing their healthcare decisions are in the hands of someone they trust.

Contents

Maryland Medical Power of Attorney Example

Maryland Medical Power of Attorney

This Maryland Medical Power of Attorney is a legal document that allows an individual (known as the "Principal") to designate another person (referred to as the "Agent") to make health care decisions on the Principal’s behalf should they become unable to do so. This document is governed by the Maryland Health Care Decisions Act.

Principal Information:

Full Name: ___________________________________
Address: _____________________________________
City/State: ____________________ Zip: _________
Date of Birth: _______________________________
Telephone Number: ____________________________

Agent Information:

Full Name: ___________________________________
Relationship to Principal: _____________________
Address: _____________________________________
City/State: ____________________ Zip: _________
Alternate Telephone Number: ___________________

In accordance with the Maryland Health Care Decisions Act, I hereby appoint the above-named Agent to make health care decisions on my behalf, including but not limited to, the power to give, withhold, or withdraw consent to medical treatment, access medical records, and make decisions about organ donation, when I am deemed unable to make these decisions for myself.

Limitations on Agent’s Authority:

Please specify any limitations on the Agent's authority to make health care decisions on your behalf:

____________________________________________________________________________________

Successor Agent (Optional):

If the primary Agent is unable or unwilling to act, I designate the following person as Successor Agent:

Full Name: ___________________________________
Relationship to Principal: _____________________
Address: _____________________________________
City/State: ____________________ Zip: _________
Telephone Number: ____________________________

This Medical Power of Attorney becomes effective immediately upon my incapacity to make health care decisions and will remain in effect until I am capable of making these decisions for myself or until it is revoked.

Principal’s Signature: ___________________________ Date: _____________________

Agent’s Signature: _______________________________ Date: _____________________

This document should be signed in the presence of two witnesses, who are not the Agent or Successor Agent, and who will not be inheriting anything from the Principal or gain financially from the death of the Principal.

Witness 1 Signature: ___________________________ Date: _____________________

Witness 2 Signature: ___________________________ Date: _____________________

By executing this Maryland Medical Power of Attorney, I affirm that I understand the nature and purpose of this document, that I am of sound mind, and that I am not under any duress to sign this document.

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Form Overview

Fact	Detail
Definition	A Maryland Medical Power of Attorney allows an individual to designate another person to make medical decisions on their behalf.
Governing Law	The form is governed by Maryland Health-General Code, §§ 5-601–5-606.
Who can be an Agent	Any competent adult can be designated as an agent, except for the individual’s healthcare provider, unless they are related by blood or marriage.
Requirements for Validity	The form must be signed by the principal and either witnessed by two individuals or notarized.
Scope of Decision-Making Power	The agent can make any healthcare decision that the principal could make, unless the document specifies limitations.
Activation	The power of attorney comes into effect when a doctor certifies that the principal is no longer capable of making their own medical decisions.
Revocation	The principal can revoke the power of attorney at any time, as long as they are competent, through a written notice or by orally informing the supervising health care provider.
Durability	The document remains effective even if the principal becomes incapacitated, unless it explicitly states otherwise.
Copy Validity	A photocopy of the original document is considered as valid as the original.

Documents used along the form

When preparing a Maryland Medical Power of Attorney (MPOA), it’s important to consider other documents that can strengthen and accompany this form. These documents ensure that a person's health care preferences are comprehensively documented, and legal rights are protected. Below is a list of seven documents often used in conjunction with the Maryland Medical Power of Attorney form.

Advance Directive: This document allows individuals to specify their preferences for end-of-life care and can include instructions about life-sustaining treatments.
Living Will: Similar to an Advance Directive, a Living Will outlines a person’s wishes regarding medical treatment if they become unable to communicate these wishes due to illness or incapacity.
Health Insurance Portability and Accountability Act (HIPAA) Release Form: This form permits healthcare providers to disclose an individual’s health information to designated persons, such as those holding a Medical Power of Attorney.
Do Not Resuscitate (DNR) Order: A physician’s order that instructs healthcare providers not to perform CPR if a patient’s breathing stops or if the heart stops beating.
Organ and Tissue Donation Registration Form: Allows individuals to register their consent to become organ and tissue donors upon death, and typically includes specific directives regarding the donation.
Medication List: While not a legal document, maintaining an up-to-date list of medications can assist healthcare proxies in making informed decisions.
Emergency Contact Form: Lists contacts to be notified in case of an emergency, including the healthcare proxy designated in the Medical Power of Attorney.

Gathering these documents together with the Maryland Medical Power of Attorney can ensure that a person’s health care wishes are clearly articulated and legally protected. It helps in creating a comprehensive health care plan that respects the individual's preferences and rights.

Consider Some Other Medical Power of Attorney Templates for Specific States

Indiana Medical Power of Attorney Form - This document should be kept in a safe but accessible place, and copies should be shared with your appointed agent, family members, and primary physician.

Power of Attorney Alaska for Child - Designed to relieve your loved ones from the burden of making difficult medical decisions during emotional times, by your advance directive.

Health Care Proxy Form Massachusetts - By completing a Medical Power of Attorney, you can have peace of mind knowing someone you trust will oversee your medical care.