How to Fill Out and Sign the Maryland Advance Directive Form

The Maryland advance directive form is a single document that lets you appoint a healthcare agent and record your treatment wishes, and you can complete it yourself without a lawyer, notary, or filing fee. The official fillable version is published by the Maryland Attorney General’s Office and available as a free download from the Maryland Department of Health.¹ The form has three parts: Part I appoints your healthcare agent, Part II records your treatment preferences (this section functions as a standalone living will), and Part III handles signatures and witnesses. To make it legally binding, you sign and date it in front of two qualifying witnesses.²

Decide These Things Before You Start Writing

Three sets of decisions drive the whole form. Working them out in advance saves a lot of scratching out.

Who will speak for you. Your primary healthcare agent should be someone you trust to follow your wishes under pressure: a spouse, adult child, close friend, or anyone who knows your values well. You also want at least one successor agent to step in if your primary is unavailable or unwilling.

What you want in each of three clinical scenarios. The form asks for your preferences across:

A terminal condition — an illness or injury with no reasonable expectation of recovery, where death is expected even with treatment.
A persistent vegetative state — permanent unconsciousness with no awareness of yourself or your surroundings.
An end-stage condition — a severe, irreversible condition that has left you unable to care for yourself and from which meaningful recovery is not expected.

For each scenario you decide whether to continue life-sustaining procedures (mechanical ventilation, CPR, artificial nutrition and hydration through a feeding tube) or receive comfort care only. Your answers can differ across scenarios. You might, for example, accept full treatment in a terminal condition but decline it in a persistent vegetative state.

Optional instructions. The form includes sections on organ and tissue donation, funeral and burial wishes, and, if relevant, how the directive should apply during pregnancy. Unlike many states that automatically override a patient’s wishes during pregnancy, Maryland leaves that decision entirely to you through the optional pregnancy sections in Part I and Part II.²

Filling Out Part I: Your Healthcare Agent

In Part I you write in each agent’s full name, address, and telephone number, starting with your primary and adding successors in the order you want them to act.

The form then asks when your agent’s authority begins. You have two choices: immediately upon signing (useful if you want your agent involved in routine medical decisions right away) or only after a physician certifies that you are unable to make informed decisions yourself. Most people choose the second option.

The default powers listed on the form are broad. Unless you write in a limit, your agent can consent to or refuse any medical procedure including life-sustaining treatment, choose your doctors and other providers, decide whether you should be in a hospital, nursing home, or hospice, ride with you in an ambulance, and visit you in any healthcare facility.³ The form has a blank space to add any conditions or limitations. You might prohibit your agent from authorizing a specific treatment, or require them to consult a particular family member before major decisions.

Filling Out Part II: Treatment Preferences

Part II is your living will, and it takes effect on its own even if you skip Part I. For each of the three clinical scenarios, you check boxes indicating whether you want all available life-sustaining treatment or comfort care and a natural death.

If you want more granularity than the two main paths, the form lets you specify individual interventions. You can accept artificial nutrition but decline mechanical ventilation, or approve CPR in a terminal condition but refuse it in a vegetative state. A write-in section handles anything the checkboxes miss: pain management preferences, where you want to receive care, spiritual practices you want honored.

The organ donation section is here as well. You can donate all organs and tissues, limit your donation to specific organs, or decline donation entirely, and you can restrict donations to particular purposes such as transplantation, research, or education. A separate area records funeral and burial wishes, including whether you prefer burial or cremation.

Signing and Witnessing (Part III)

Maryland law requires the directive to be dated, signed by you (or by someone else at your express direction if you are physically unable to sign), and witnessed by two adults.⁴ Two rules about who can witness catch people out:

Your healthcare agent cannot be a witness. Any successor agent you named is also ineligible.
At least one witness must be someone who is not entitled to any portion of your estate and does not stand to benefit financially from your death.⁴

Any other competent adult can serve, including a physician, nurse practitioner, or employee of a facility caring for you. Both witnesses must be in your presence when you sign, and each witness then signs and provides their own contact information, attesting that you appeared competent and acted voluntarily.

Notarization is not required.² Some people notarize anyway for peace of mind or in case they spend time in a state that does require it, but it adds no legal effect in Maryland.

Signing Electronically

Maryland law explicitly allows electronic advance directives. You can sign electronically, and your witnesses can be present by electronic means rather than in the same room.⁴ The state also accepts unwitnessed video advance directives — recorded statements of your wishes — as long as the video is dated and stored through an electronic advance directive service recognized by the Maryland Health Care Commission, such as MyDirectives.

Make Sure Your Directive Can Be Found

A signed directive does no good if the emergency room cannot find it. The Maryland Department of Health partners with MyDirectives, a free online platform, to let you upload and store your completed directive digitally.¹ MyDirectives connects to CRISP, Maryland’s statewide health information exchange, so hospitals and emergency departments across the state can pull up your directive during a crisis.⁵

Beyond registering electronically, hand copies to the people who need them:

Your healthcare agents. They should know they were named, and know what your wishes are, before a crisis hits.
Your primary care physician, with a request to add it to your electronic medical record.
Close family members, even if they are not your agents, so they know the document exists and who your agent is.

Keep the original somewhere accessible in an emergency. A bedside drawer or a home filing cabinet works better than a safe deposit box, which may be impossible to open at 2 a.m. on a Saturday.

When Your Directive Actually Takes Effect

The directive is dormant until you are certified as unable to make informed medical decisions. Under Maryland law, your attending physician and a second physician or nurse practitioner must each examine you and certify in writing that you lack decision-making capacity.⁶ If you are unconscious or completely unable to communicate, your attending physician’s certification alone is sufficient. Once that happens, your agent’s authority activates (assuming you chose the “upon incapacity” trigger) and your Part II preferences become binding on your medical team. If you recover capacity, the directive goes back to sleep and you resume making your own decisions.

Changing or Revoking It Later

You can revoke your advance directive at any time while you are competent, using any of these methods:⁷

Sign and date a written or electronic revocation.
Physically destroy the original by tearing, shredding, or otherwise.
Tell a healthcare practitioner orally that you are revoking it. The practitioner and a witness then document your statement in your medical record.
Sign a new advance directive, which automatically replaces the prior one.

Maryland law also lets you voluntarily include a provision waiving your right to revoke the directive during any period when you have been certified incapable of making informed decisions. This is rare, but it can matter for people worried about revoking instructions during a psychiatric crisis or a period of confusion. If you leave that provision out, you keep full revocation rights at all times.

After revoking, notify anyone who has a copy so old versions do not float around, and update or remove the stored document in MyDirectives if you registered it. Review your directive every few years, and any time a major life change occurs, such as a marriage, divorce, serious diagnosis, or the death of a named agent.

If You Also Spend Time in Another State

Maryland will honor an advance directive made in another state to the extent it is consistent with Maryland law.² Whether another state will honor your Maryland directive depends on that state’s own laws. If you split time between Maryland and another state, completing a directive in each is the safest approach. At a minimum, sign and witness your Maryland directive in a way that also satisfies the other state’s requirements, adding notarization if that state requires it.

1
Maryland Department of Health. Maryland Advance Directive Program – Individual Resources
2
Maryland Office of the Attorney General. Maryland Advance Directive – Planning for Future Health Care Decisions
3
Maryland General Assembly. Maryland Code Health-General 5-603
4
Maryland General Assembly. Maryland Code Health-General 5-602
5
CRISP. Advance Directives
6
New York Codes, Rules and Regulations. Maryland Code Health-General 5-606 – Certification of Incapacity
7
Maryland General Assembly. Maryland Code Health-General 5-604 – Revocation of Advance Directive