Maine Health Care Advance Directive Form Page 2
Download a blank fillable Maine Health Care Advance Directive Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Maine Health Care Advance Directive Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
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14Note
You may change any part of this form except for Part 6 and Part 7. You may cross out any words, sentences, or
paragraphs you do not want. You can also add your own words. If you make any changes to the form, it is best
if you put your initials and the date next to each change so that everyone knows it was your decision to make
the change. The form lets you choose different ways to handle your care by checking boxes or filling in blanks.
You may initial each box and each blank you fill in to show that it was your decision to check the box or fill in
the blank.
Before filling out this form, we suggest that you talk with your lawyer, family members, physicians, and others
close to you about your wishes. If you make changes or complete a new form, be sure to let everyone know.
My Name (please print)______________________________________________________
My Address _______________________________________________________________
My Birth date______________________________________________________________
This is a list of all the people who have copies of my signed health care advance directive:
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
5. ________________________________________________________________________
6. ________________________________________________________________________
7. ________________________________________________________________________
8. ________________________________________________________________________
9. ________________________________________________________________________
10. ________________________________________________________________________
Page 2 of 14
Revised February 2008
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