Health care directive in Maryland: form, signing and who decides
The form, who can witness, who can be your agent and who decides if you have no directive in Maryland.
Checked against official sources: October 31, 2026.
Short answer
Advance Directive (Maryland Health Care Decisions Act)
- How to sign
- Signed in front of two witnesses (no notary)
- Who decides without a directive
- Yes
The document and its form
- Document
- Advance Directive (Maryland Health Care Decisions Act)
- Official form
- Maryland Advance Directive: Planning for Future Health Care Decisions (Part I health care agent, Part II treatment preferences/living will, Part III signature and witnesses)Published by Maryland Department of Health, Advance Directive Program (accessible version prepared from the Office of the Attorney General's May 2024 forms; the Attorney General's former form page now redirects to its homepage)Version: Prepared from the May 2024 Attorney General forms; PDF modified April 2026
You do not have to use it.
- Living will
Part II: Treatment Preferences ('Living Will')
Part of the directive.
Maryland's advance directive form has a living will section (Part II) for your treatment preferences, such as about life-sustaining procedures. You can fill in Part I, Part II or both, then sign in front of two witnesses.
Law: Md. Code, Health-Gen. §§ 5-602, 5-603
Signing rules
- How to sign
Sign and date the advance directive in front of two witnesses who also sign it. No notary is needed. You can also make an oral advance directive in front of your attending physician, physician assistant or nurse practitioner and one witness, documented in your medical record.
- Who signs
Dated and signed by you, or at your express direction.
- Notary
- Not required
- Witnesses
- 2
- Who cannot witness
Any competent individual may witness, including a health care facility employee or your physician, physician assistant or nurse practitioner acting in good faith. Your health care agent cannot be a witness. At least one witness must not knowingly be entitled to any part of your estate or any financial benefit from your death.
- Nursing facilities and special settings
An owner, operator or employee of a health care facility where you receive care (or their spouse, parent, child or sibling) cannot be your agent unless they would qualify as your surrogate or you named them before you began receiving care there.
- Electronic signing
An electronic advance directive may be witnessed in the electronic presence of the witnesses. The State-designated health information exchange may accept an unwitnessed, dated video advance directive stored by an electronic advance directives service recognized by the Maryland Health Care Commission; an unwitnessed electronic directive must be submitted to such a service.
Law: Health-Gen. §§ 5-602(c), 5-623(c)
Law: Md. Code, Health-Gen. § 5-602
Who can be your agent and what the agent can do
- Who cannot be your agent
Any adult, except: an owner, operator or employee of a health care facility treating you (or their close relative), unless they would qualify as your surrogate or were named before you began receiving care there; a person subject to a protective order protecting you; and your spouse after a separation agreement or divorce filing, unless you still want them to serve.
Law: Health-Gen. § 5-602(b)
- When the agent starts
Unless your directive says otherwise, it takes effect when your attending physician and a second physician certify in writing that you are incapable of making an informed decision (only one if you are unconscious or cannot communicate).
Law: Health-Gen. § 5-602(e)
- Decisions an agent cannot make
Without an agent, life-sustaining procedures may be withheld under a directive or by a surrogate only if two practitioners certify a terminal or end-stage condition, or two physicians (one with cognitive expertise) certify a persistent vegetative state. You may choose in your directive to waive your right to revoke it while you are certified incapable.
Law: Health-Gen. § 5-606(b); § 5-604(a)(2)
Revoking and conflicting documents
- Revoking your agent
You can revoke an advance directive, including your choice of agent, at any time by a signed and dated written or electronic document, by cancelling or destroying it, by telling a health care practitioner, or by making a new directive. An oral revocation must be documented in your medical record by the practitioner and a witness.
- Revoking your instructions
The same methods apply to the rest of the directive.
- Telling others
You are responsible, as far as reasonably possible, for telling anyone who has a copy. If the directive is registered with an electronic advance directives service, you must notify the service.
Law: Health-Gen. § 5-604(c); § 5-623(b)
- Divorce ends a spouse's authority
- Yes · Divorce rules in Maryland (Divorce Law Map)
Law: Md. Code, Health-Gen. §§ 5-602(b)(3), 5-604
If you have no directive
- Who decides without a directive
If you have been certified incapable and have no available agent, people in this order may decide; a lower class may decide only if everyone in the higher class is unavailable. A spouse after a separation agreement or divorce filing, or a person under a protective order, cannot decide. If people in the same class disagree in a hospital, the case goes to the patient care advisory committee.
- A guardian
- Your spouse or domestic partner
- An adult child
- A parent
- An adult brother or sister
- A friend or other relative who gives the attending physician an affidavit showing regular contact with you
Law: Md. Code, Health-Gen. § 5-605
Other states, registry and medical orders
- Signed in another state
An advance directive, EMS do-not-resuscitate order or life-sustaining treatment order made in another state is valid in Maryland if it follows Maryland law or the law of the state where it was made.
Law: Health-Gen. § 5-617
- POLST (medical orders)
Maryland Medical Orders for Life-Sustaining Treatment (MOLST)
- Mental health directive
You can make an advance directive for mental health services, following the same signing and revocation rules as other advance directives. It can name an agent for mental health decisions, preferred providers and medications, and instructions on releasing information.
Law: Health-Gen. § 5-602.1
Law: Md. Code, Health-Gen. §§ 5-619 to 5-623; Md. Code, Health-Gen. § 5-608.1
Free notice: revoke or change a health care directive
Free help in Maryland
- Maryland Legal Aid · 888-465-2468
- Maryland Courts: Alternatives to Guardianship
- Maryland Courts: Guardianship forms
- Maryland Department of Health: Advance Directive Program
- Maryland Department of Health: Advance directive forms and resources
- Find free legal aid at LawHelp.org
Report abuse or exploitation
Adult Protective Services (Maryland Department of Human Services, local departments of social services) · 1-800-917-7383
Questions about powers of attorney in Maryland
How do I sign a health care directive in Maryland?
Sign and date the advance directive in front of two witnesses who also sign it. No notary is needed. You can also make an oral advance directive in front of your attending physician, physician assistant or nurse practitioner and one witness, documented in your medical record.
Who decides my health care if I have no directive in Maryland?
If you have been certified incapable and have no available agent, people in this order may decide; a lower class may decide only if everyone in the higher class is unavailable. A spouse after a separation agreement or divorce filing, or a person under a protective order, cannot decide.