Advance Health Care Directive Forms
Marylandís Advance Directive documents are available on the website of the Montgomery County Coalition on End-of-Life Care. Translations are available in Spanish, Chinese, Korean, Vietnamese, French and Russian.
There is also a simplified advance directive called the Choice of Health Care Agent Advance Directive available at this site. This
self-explanatory form allows a person to name a health care agent
(also called a medical power of attorney) for himself. A health care agent can make health care decisions and advocate for someone who either cannot do these things for himself, or simply prefers to let his health care agent do them for him.
Five Wishes Document - Document that helps you express how you want to be treated if you are seriously ill and unable to speak for yourself. Addresses medical, personal, emotional and spiritual needs. Also encourages discussing your wishes with your family and physician. It can be viewed for free; $5 charge for printable version. Contact Aging with Dignity at www.agingwithdignity.org or call 1-888-594-7437.
File for Life: Personal Planning for Medical Emergencies/Maintaining Health Records is a communication tool that rescue workers use to get quick information about a personís medical situation. It includes information about the existence and location of an individualís advance directive and ďDo Not Resuscitate Order.Ē
To request a free File of Life, call the Senior Resource Line at
240-777-3000 (Voice) or 240-777-4575 (TTY).
Download a Wallet Card - States that you have an advance directive. Contact the American Hospital Association at www.putitinwriting.org
Download the newest Life - Sustaining Treatment Options Form from the State Attorney Generalís office at www.oag.state.md.us/healthpol/