How to Fill Out Maryland’s Health Care Proxy Form (Advance Directive)

Maryland’s health care proxy form is officially called the Maryland Advance Directive, and the version published by the Maryland Attorney General lets you both name a health care agent and record your treatment wishes in a single document.¹ You fill it out yourself. No lawyer, no notary, no filing fee. The form is governed by the Maryland Health Care Decisions Act at Health-General §§ 5-601 through 5-618, and any written document that meets the signing rules is valid, but the Attorney General’s form is the easiest starting point because it walks you through every option Maryland law recognizes.²

Who Can Fill It Out and Who Can Be Your Agent

You must be at least 18 and competent, meaning you understand what you are signing.¹ The form is modular, so you can complete just the agent section, just the treatment preferences, or both.

Your agent cannot be an owner, operator, or employee of a health care facility where you are receiving care. There are two exceptions: that person already qualifies as a surrogate under Maryland law (spouse, adult child, parent, or adult sibling), or you appointed them before you entered the facility.³ A separated or divorcing spouse is disqualified unless you specifically reaffirm the appointment.

What to Have in Front of You Before You Start

Pull this information together first so you can complete the form in one sitting:

Your primary agent’s full legal name, address, home phone, and cell phone.
The same contact information for up to two back-up agents.
Names of any people you want your agent to consult before making major decisions (optional).
Your date of birth or the last four digits of your Social Security number, which the form uses as an identifier.

Pick an agent you trust to follow your wishes, who can stay calm under pressure, and who has agreed to serve. Have the conversation before you write their name down.

Part I: Naming Your Health Care Agent

Section A takes your primary agent’s name, address, and phone numbers. Section B does the same for a first and second back-up. If your primary agent is unreachable or unwilling to act when the time comes, the first back-up steps in automatically, then the second.

Section C spells out your agent’s powers. Under the standard form, that includes consenting to or refusing any medical procedure (ventilators and feeding tubes included), choosing your doctors and other providers, and deciding where you receive care, whether that is a hospital, nursing home, hospice, or elsewhere.⁴ The form also gives your agent the right to ride in the ambulance and visit you in any facility.

Section D tells your agent how to decide: look at your Part II instructions first, then weigh your conversations, religious beliefs, values, and personality. If your wishes still are not clear, the agent chooses what they believe is in your best interest. Section E is the optional list of people you want consulted. Section F is where you write any specific wishes about how your directive should apply during pregnancy.

When Your Agent’s Authority Begins

Section H asks you to initial one of two choices. The first makes your agent’s authority effective as soon as you sign, though you keep the right to make your own decisions whenever you are able and want to. The second — the more common pick — holds your agent’s authority in reserve until a doctor determines you cannot make informed decisions, whether temporarily or permanently.¹ Initial clearly in the blank next to whichever option you choose.

HIPAA Access

Section G makes your agent your personal representative under the federal HIPAA privacy rule, giving them legal authority to see your medical records and talk with your providers. Complete this section and you will not need a separate HIPAA release.

Part II: Your Treatment Preferences

Part II is the living will portion. The form addresses three distinct medical scenarios, and you initial one of three treatment options under each:⁴

Terminal condition: an incurable illness where death is expected even with treatment.
Persistent vegetative state: a permanent condition of unconsciousness with no awareness of yourself or your surroundings.
End-stage condition: an advanced, irreversible condition caused by injury or illness that has resulted in severe and permanent deterioration.

For each scenario, the first option asks doctors to try life-sustaining treatments for a reasonable period. The second directs providers to withhold life-sustaining procedures but lets you decide separately whether you still want artificially administered nutrition and fluids. The third tells providers not to use life-sustaining treatments at all. The options are not identical across the three scenarios, so read each set carefully. Your answers can legitimately differ depending on the condition.

Pain Relief and How Strictly to Follow Your Wishes

Section E is a standing instruction: whatever else you have chosen, you are to receive the medication or treatment needed to control pain. Section G then asks whether your agent and doctors should follow your stated preferences exactly, or whether you want to give your agent flexibility to deviate when they believe doing so is in your best interest. Initial the “strictly bound” option if you feel firmly about your choices. Initial the flexibility option if you would rather let your agent adapt to situations you cannot predict.

A doctor is never required to provide treatment they consider medically ineffective, even if your directive asks for it.¹

Writing Instructions in Your Own Words

Section A at the top of Part II gives you space to describe your goals, values, and what quality of life means to you. The initials elsewhere in the form only cover three defined conditions. Real medical situations rarely fit those boxes cleanly. A paragraph in your own words gives your agent a compass for everything the checkboxes do not cover, and it is probably the single most useful thing you can write on the entire form.

Signing the Form and Choosing Witnesses

Part III makes the document legally binding. You sign and date in the presence of two witnesses, each at least 18 years old, and both witnesses then sign in your presence.³ Two rules govern who can witness:

Your health care agent cannot be a witness. Back-up agents can.
At least one of the two witnesses must be someone who will not knowingly inherit anything from you or otherwise benefit financially from your death.⁴

No notarization is required. An electronic directive, signed electronically with witnesses present electronically, is also valid under current Maryland law.³

What to Do With the Signed Form

A directive in a drawer helps no one. Distribute copies so providers can find it when they need it:

Give a copy to your agent and each back-up agent.
Give a copy to your primary care doctor and any specialists you see regularly, and ask that it be added to your medical record.
Carry a wallet card noting that you have a directive and where it is kept.
Bring a copy with you to any hospital admission. Do not assume the hospital already has it.¹

Maryland’s Health Information Exchange, CRISP, recognizes MyDirectives.com as an authorized electronic advance directive service under COMAR § 10.25.19.⁵ If you upload your signed form at MyDirectives.com/Maryland, clinicians querying CRISP can pull it up electronically, including from an emergency room.⁶ The upload supplements paper copies, it does not replace them.

One Thing a Proxy Form Does Not Do

The advance directive records your wishes. It does not give emergency medics an order they can act on. If you do not have a Do Not Resuscitate order on a Maryland MOLST (Medical Orders for Life-Sustaining Treatment) form, paramedics are required to attempt resuscitation regardless of what your advance directive says.⁷ If you have strong preferences about CPR or other emergency interventions, ask your doctor about completing a MOLST form alongside your directive.

Changing or Revoking Your Directive

You can revoke the directive at any time by any of these methods:⁸

Sign and date a new written or electronic document saying you are revoking it.
Physically destroy the document by tearing, shredding, or crossing it out.
Tell a health care practitioner orally that you are revoking it. The practitioner and a witness must then document what you said in your medical record.
Sign a new advance directive, which automatically supersedes the old one.

After revoking, notify everyone who has a copy, including MyDirectives.com if you uploaded it there.

What Happens Without a Signed Form

If you become incapacitated without a directive, Maryland law assigns a surrogate decision-maker from a fixed priority list: court-appointed guardian first, then spouse or domestic partner, adult child, parent, adult sibling, and finally a friend or other relative who can provide an affidavit of regular contact.⁹ A lower-ranked person acts only if everyone above is unavailable, unwilling, or incapacitated. An estranged spouse outranks an adult child who has been your primary caregiver. Siblings of equal rank may disagree. Completing the proxy form lets you skip that hierarchy entirely and put the person you actually trust in charge.

1
Maryland Office of the Attorney General. Maryland Advance Directive Planning for Future Health Care Decisions
2
Maryland General Assembly. Maryland Code Health-General 5-602 – Advance Directive
3
Maryland General Assembly. Maryland Code Health-General 5-602 – Procedure for Making Advance Directive
4
Maryland General Assembly. Maryland Code Health-General 5-603 – Advance Directives Form
5
CRISP. Advance Directives
6
Maryland Department of Health. Maryland Advance Directive Program
7
Maryland MOLST. Maryland MOLST
8
Maryland General Assembly. Maryland Code Health-General 5-604 – Revocation of Advance Directive
9
Maryland General Assembly. Maryland Code Health-General 5-605 – Surrogate Decision Making