Maine Medical Power of Attorney (POA) Form

The Health Care Advance Directive is a document that allows a person to choose a reliable agent or attorney who will act in critical conditions and situations of crisis. If a person (or a declarant) becomes disabled and unconscious or suddenly faces a vegetative state, coma, or a similar physical condition, the agent appointed by the medical power of attorney form will take care of the decisions regarding the declarant.

The agent or attorney will be responsible for continuing or stopping the treatment, accepting or refusing it for the declarant. This is a vital document in the United States, especially for the people that have already gotten sick and have severe disease or those who are older than a certain age. Also, the health advance directive form lets the agent or attorney act in case of an accident when the victim has had serious injuries and has become disabled.

Maine power of attorney templates – find out more about other powers of attorney used in Maine.

In the medical poa, you will leave special instructions that depend on your will. These instructions may tell about:

  • Medical care in general
  • Preferred treatment
  • Live-sustaining procedures

And other things tied to your health care in critical conditions.

Every state in the US has different rules and laws regarding the health advance directive form. In some states, you will need to notarize the form. Others ask for a witness or two witnesses to make the form valid.

Maine Laws and Requirements

As stated in section § 5-803(2) of the Maine state law, signing a form should be accompanied by two witnesses. You should be over 18 (or under this age but have the rights of an adult) and in sound mind.

You are to choose the future agent very carefully because one will make medical decisions for you. An agent can be any adult except for one from the medical staff of the hospital where you get treatment. But if at the same time one is your relative, then one can be.

The signatures of you and other people involved should be written. After the signing process, an agent gets access to all your medical records for understanding what the right decision one must make on your behalf.

In Maine, you (as a declarant) may add three agents in your health advance directive form. Do not forget to state the type of relationship that connects you with your agent (or agents).

Filling Out the Form

We have prepared a detailed guide with all the required steps so you can easily complete the health care advance directive form in Maine. You may see this guide below.

  • Download the Template

To start, you need to download the template of the health care advance directive form. To make it simple, use our form building software.

  • Insert Information about Yourself and the People who Get the Copies

In the first section, you are to insert your full legal name, your place of residence, and your birthday. Then you can see ten blank lines. Here you need to specify the full names of people who have copies of this document.
Part for information about principal and people who get copies of Maine mpoa form

  • Choose Your Agent (or Agents)

After you have placed your personal details, proceed to the next section. Add the name of your agent and the type of relationship that ties you together. Below the name of this person, add his or her best phone number and home address.

You may appoint three agents in your health care directive form in Maine. Below the details of your initially chosen agent, add the information about one or two additional agents. This is needed because sometimes your initial agent may also become unavailable or unable to act in accordance with your MDPOA form.

Apart from the telephone numbers and home addresses, you also need to state the type of relationship that connects you with your additional agent or agents.

If you don’t want a particular person to be your agent anymore, you have a section below that you can fill out later. But do not forget to make a new copy of this paper and give it to your close people and physician.
Agent choosing section of a Maine medical power of attorney document

  • Fill out the Instructions for Your Agent

In this section, you should leave the instructions for your agent. They may include all the information about your will regarding your health conditions and medical care, including life-sustaining procedures, treatment, and other aspects.

In these lines, you may also add some instructions that can limit or increase the responsibilities of your agent.

This section is optional: you may leave it blank if you fully trust your agent or have transferred the instructions in any other way.

If the judge states that you need a guardian, you can specify here that you want your agent to be your guardian.
Agent instructions part of medical power of attorney for Maine

  • Add the Information about Your Physician

In this section, you are to place the full name, place of residence, phone number of the physician, one’s assistant, and the nurse.
Section for information about physician of a mpoa for Maine

  • Specify the Information about the Donation and the Burial Process

In these sections, you can choose whether you want to donate your organs (and which particularly) and in what way to be buried (if you want, of course). You can also add the names of people who you want to learn about your last wishes.
Part for information about donation and burial process of medical power of attorney form for Maine

  • Sign the Health Care Advance Directive Form

You are to sign the form and put a date of signing and your address.
Signing part of health care advance directive form of Maine

  • Ask Witness (or Witnesses) and Notary to Sign 

In this section, witnesses and the notary are to sign the form and put a date of signing and your address.
Witness and notary signing section of a Maine mpoa document

  • Leave Special Instructions about Your Revival (If Needed)

If you want to be revived, you need to fill out this form too, and notify your physician and give one the form to put the special information.
Special instruction about evival part of a Maine medical power of attorney template

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Published: Nov 19, 2020