Maryland Medical Power of Attorney (POA) Form

In the United States, the “Medical Power of Attorney” form (or MPA form) is a vital document that states the declarant’s wishes about health care if he or she is incapable of decision making anymore. With the medical power of attorney form, everyone in the US may appoint another person who will be responsible for taking care of the medical matters in some cases.

For example, among those cases are accidents that lead to serious traumas (up to a coma or similar state) or severe illnesses that make a person disabled (for instance, putting him or her in a vegetative state). With the MPA form, one may be sure that his or her life is in safe hands because the appointed agent will act in conformity with the declarant’s will.

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In the state of Maryland, the MPA is the initial part of the local version of the “Advance Directive” form (or the AD form).

The MPA form usually includes not only a designation of someone to be your agent but also your instructions regarding:

  • General health care
  • Procedures to sustain your life
  • The treatment you would opt for

And any other instructions you may think of while leaving your healthcare directive. In the AD form in some states, you also may add wishes regarding the cremation or burning of your body and other thoughts related to the processes that happen to your body after death.

There is no unified sample of such a directive or MPA form in the US. Each state has its own laws and recommendations that regulate the creation of this form. Some states require notarization of the MPA form; in others, you will need to call a witness (or two) to sign the papers.

Maryland Laws and Requirements

You may find detailed information about the AD form in Maryland in paragraph 5-603 of state law (“Statutes”). A declarant does not need to call a notary for signing the form. However, two witnesses are required by law.

The AD form in Maryland contains ten pages, but it is not difficult to complete. These pages have many various sections and suggest you clearly and fully state your wishes. We recommend you defining who will be your agent in critical conditions, thinking of people who may be your “backup agents” (and act in case your initial agent is not available for some reason), and deciding which instructions will you leave regarding your health and procedures.

In Maryland, as a declarant, you can appoint two backup agents in the AD form.

Maryland Medical Power of Attorney Form Details

Document Name Maryland Medical Power of Attorney Form
State Form Name Maryland Advance Directive
State Laws Maryland Annotated Code, Sections 5-601 to 5-618
Signing Requirements Two Witnesses
Who Can’t Be the Agent? Section 5-602(b)
Who Can’t Be the Witness? Section 5-602(c)
Avg. Time to Fill Out 8 minutes
# of Fillable Fields 21
Available Formats Adobe PDF

Filling Out the Form

To make the completion of the AD form quick and easy for you, we have created the instructions that might be useful if you are signing the document in Maryland. You may find the details below.

1.   Download the Form Template

To create the AD form in Maryland, you should download it. Try to use our form building software to accelerate the completion process.

2.   Add Your Details

Below the heading of the AD form, you (if you are the declarant) have to add your name and date of birth.
Details adding section of a Maryland medical power of attorney document

3. Learn about the Basic Rules of AD Form Completion

In Maryland, on the initial page of the AD form, you will see a brief text that explains which parts you should fill out in any case, which sections are optional and other details. Read this part carefully.

The AD form in Maryland consists of three main parts. You can choose to complete the first, the second, or both parts 1 and 2. However, the third part is mandatory: the declarant’s signature and the witnesses’ verification should be placed there.

The authors of the form recommend making a sufficient number of copies of your directive: give it to the agent, to your personal physician (if applicable), and to other people that might need it. From time to time, you may re-read your AD and create a new paper if your wish becomes different.

4. Proceed to Part I

In this part, you will insert your agent’s name and address. You should also leave his or her telephone number (or numbers) — as many valid numbers as possible.
Part for filling out Part I of a document of mpoa for Maryland

5. Choose Your Backup Agent(s)

In Maryland, it is not mandatory to choose additional agents. However, it is usually recommended because your initial agent might become unavailable or unable to act. So, you may add two agents: insert their names, addresses, and telephone numbers as well.
Backup agent choosing section of Maryland ad form

6. Delegate the Powers to Your Agent

Further, you will choose what to delegate to your agent. Opt for the items on the list.
Powers delegation of a Maryland medical power of attorney form

7. Add Special Conditions

In the blank field of the next section, you may leave the special conditions that may decrease or extend your agent’s powers.
Special conditions adding part of Maryland mpoa template

8. Include Someone Who Your Agent Can Consult

Unlike many other states, in Maryland, you may add a person (or people) that your agent can contact and consult if it is needed. Here, you should insert only names and valid telephone numbers. This field is optional, and you may leave it blank.
Part for information about agent's consultant of ad form for Maryland

9. Leave Instructions in Case of Pregnancy

Here, you may attach the instructions that your agent will use in case you are pregnant (this section is for ladies only).
Instruction in case of pregnancy section of a Maryland medical power of attorney

10. Choose the Effectiveness Date

By placing your initials, choose one of the preferred options that describe the effectiveness of your AD form.
Effectiveness date choosing section of a mpoa form for Maryland

11. Proceed to Part II

Remember that you may complete only the first part and skip the second part. However, the second part might also be extremely useful for making decisions about you. In the second section, you will add the details about the treatment you prefer. Choose among all of the options wisely.
Section for filling out Part II of Maryland medical power of attorney template

12. Sign the AD Form

In Part III of the AD form, you should sign the papers and add a date when you are signing.
Signing part of Advance directive form of Maryland

13. Give the AD Form to Your Witnesses

Below your signature, two witnesses should sign, add the relevant date, and their valid phone numbers. Remember that none of your witnesses can act as your agent. Also, remember that the AD form notarizing is not required in Maryland by law.
WItnesses signing section of Maryland ad form

seal of maryland state

Other Maryland Forms

Use our document builder to customize any form offered on FormsPal to your preferences. Here is a range of various other fillable Maryland forms we offer.

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Published: Nov 19, 2020