The Maine health care advance directive offers a person the chance to pick a medical care representative to settle on choices if they can't do that by themselves due to being incapacitated. Also, the choice to sort out life-ending inclinations, burial plans, and other normal worries have been added to the document. An advance directive contains a living will and clinical authority of an attorney joined together to form a single document.
Statute – § 5-803
Signing Requirements (§ 5-803(2)) – Two adult witnesses, none of them should be the medical agent, the beneficiary of the principal’s estate, or the health care providers.
State Definition § 5-802(1) – "Advance health care directive" signifies singular guidance from, or a power of attorney for medical care by, a person with capacity.
1. Principal Name. The Principal of Maine’s complete name ought to be utilized in the proper section. The Principal of Maine is the patient in the future that will be stood in for by a particular person when a clinical condition makes them (principal of Maine) incapable of communication with Maine Healthcare Personnel.
2. Maine Health Care Agent. For a Medical Care Representative in Maine to have the Declarant authority to speak with doctors in Maine for the benefit of the Patient or Declarant in Maine, the person should be delegated by name to this job. The name of the Representative is likewise required to be supplied.
3. Relationship Held. Normally, the medical care representative in Maine that is delegated will be an individual that is trustworthy enough to know about your clinical inclinations and execute them when you find yourself in a state of incapacitation or unconsciousness and unfit to speak. The relationship you have with this representative should be supplied where needed.
4. Maine Health Care Agent Address And Phone Numbers.
5. Choice 2 Health Care Agent Name And Contact. Doctors in Maine will search out your clinical choices on specific operations regardless of whether your Medical care Representative is inaccessible, reluctant, or their authority is renounced. Subsequently, a second option for your Medical care Representative in Maine is made possible by utilizing this form. Such an arrangement will make your second choice able to replace your first option for a representative. To appropriately choose your Second option of Medical Care Representative in Maine, their complete name should be properly supplied, the relationship they have with you as the principal should also be recorded, then lastly the residential address and contact information of the second option for medical care representative should be documented so that he or she can be contacted with ease.
6. Choice 3 Health Care Agent Name And Contact. This form considers a situation where it is possible that your 1st and 2nd option for Medical care Representatives are both inaccessible or unfit to address your needs adequately. By naming a 3rd individual to be your third choice for Medical care representative in this form, the individual can be ascribed the authority to address your clinical choices if both the first and second choices are ineffectual or disavowed.
7. Revoked Agent. As referenced before, there might be a reason to deny the authority this form awards to at least one of the medical care representatives in Maine. It is unequivocally proposed that a repudiation of the medical care representatives in Maine authorities be recorded as a hard copy as well as ensuring that each Medical Personnel in Maine is kept informed. This form can be utilized to disavow the authority ascribed to at least one of your Representatives by naming the Revoked individual’s complete name to the declaration executed.
8. Signature Update. In order for you as the Declarant in Maine to revoke the medical care representatives in Maine authority, your signature is required.
9. Date Of Signature Update. The date you provided when signing this document is what will be utilized to characterize the time the medical care representatives in Maine’s authority was dropped or revoked. Please note that this segment of this form is only to be finished if you have the aim to deny or drop this form or the authorities allowed one of your Medical Care Representatives.
Select Item 10 Or Select Item 11
10. Upon Incapacitation. If the medical care representative in Maine has your approval to start giving Medical Personnel your therapy and treatment inclinations just when you are unable to communicate while needing medical care, then the first declaration should be duly selected.
11 Immediate Grant of Power. Upon the execution of this form, you can ascribe the medical care representative in Maine the ability to discuss your medical choices with doctors and other Health care personnel. It ought to be referenced that your clinical choices can't be abrogated by your medical care representative in Maine, nonetheless, the person in question can keep particulars with respect to clinical therapies and treatments when you ask and also can perform different capacities under your instructions (for example getting to your clinical records or history).
12. Make An Agent Nomination For Guardian. Notwithstanding the Maine Representative named up to this point, the Principal or Declarant can consider the situation where the courts conclude that a Representative that is Bonded ought to be named as Conservator or Guardian. While the Maine Declarant would not possess the ability to select this individual, the person can make an assignment to the Medical care Representative or Healthcare Attorney-in-Fact for the job of a Guardian or Conservator appointed by the court by providing an indication to the designation declaration.
13. Nominate A Separate Party For Guardian. If you don't wish to assign the medical care representative in Maine for the role of the Guardian appointed by Court job in the State of Maine yet might want to select an alternate individual, then, at that point, you might do as such using the region given to administer the identity of your Nominee and also how both of you are related (for example Parent, Sibling, and so forth) Normally, the contact details (residential address and telephone numbers) that will be required to be able to contact with ease the individual you have nominated for Guardian appointed by Court ought to be supplied also.
Select Item 14 or Item 15
14. Choice Not To Be Kept Alive. The Principal in Maine should ensure this report is an exact depiction of the therapy the person in question wishes to utilize or deny whenever he or she is in a state of coma (unconsciousness) or close to the end phases of a life-threatening or incurable ailment. For example, the Principal in Maine can set a course of events for the denial of medication (that is, the individual in question might desire to be administered fluid or help with respiration for a time during a state of coma). All such guidelines can be conveyed in the discretionary segment given. Be exhorted that any order not detailed in this document or referred to by the title and appended won't be viewed as a piece of this report. Ensure all Declarant connections are available during the signing of the document.
15. Choice to Be Kept Alive. The primary authoritative guidance needed from the Declarant in Maine is introduced as a decision. On the off chance that the Declarant in Maine is in a state of unconsciousness (coma) because of a critical medical ailment (that is, they are survivors of a mishap that is life-threatening or entered into a state of unconsciousness from an already existing medical ailment) then, at that point, Medical care personnel in Delaware will legitimately look for the consent of the Principal to utilize methods that supports life or methods that prolong life to keep their body from decaying. This might include strategies going from dialysis to intubation contingent upon the Maine Declarant's condition and the laid-down therapy reactions needed by the Maine and significant Hospital. To ascribe a quick ascent for procedures that prolong life to be utilized as it is important to keep the Declarant in Maine from dying, the person should carry out Statement 1. On the off chance that this doesn't meet the Maine Declarant's choice with this order, then it ought to be left untouched.
Select Item 16 Or Item 17
16. Choice Not To Be Kept Alive. It can be said that some brain damage can cause irreversible and extreme dementia which keeps Patients from monitoring their environmental elements, can cause unsafe hallucinations, or impedes memory to some extent where friends and family are not perceived, or everyday support needs can't be finished. At the point when this occurs, you might require to be subjected to procedures that are life-prolonging in order to remain alive even when you are lacking knowledge or awareness of the situation you are in. If you don't want Doctors in Maine to utilize methods that are life-prolonging if you find yourself in a late phase of an illness that is neurological, for example, Alzheimer's Ailment and some other diseases which cause extreme dementia, then, at that point, you should choose the best option introduced.
17. Choice To Be Kept Alive. If preferred, you can announce that you desire to get any lawfully accessible clinical treatment with the objective of sustaining your life (that is, systems that support life-like intubation or dialysis) in case this is expected to prevent you from dying when you find yourself in advance phases of Alzheimer's Disease or serious dementia. The suitable declaration to make this proclamation should be duly selected, remembering, that such a move will be made a priority over any other instructions issued by the medical care representative in Maine you choose.
Select Item 18 Or Select Item 19
18. Denying Tube Feeding Directive. Whenever a patient is in a state of incapacitation the odds of the person in question being not able to eat or drink physically can make him or her starve or dehydrate. Since most times a hand-helped feeding might be inadequate or dangerous, the subject of administering artificial nutrition and water (that is, a tube or intravenously) will be tended to by going to doctors in Maine. The Declarant can illuminate all Maine Health Care Providers that the individual in question will prevent any artificial form of nutrition or delivering water through this document by choosing the first assertion in this segment.
19. Consenting To Tube Feeding. If you desire to agree to an artificial form of delivering nourishment and water when you can't take them physically on your own yet just for a restricted measure of time, the second declaration should be selected. This choice will require further definition that might be given later in this segment.
20. Your Instructions on Pain Management. A significant choice that is regularly confronted when a Maine Patient can't speak coherently or manage a critical medical ailment is the treatment objectives the individual desires to be administered by the attending Physician. If you desire to get a natural demise (because of a critical or serious condition) and just wish for clinical therapy and medication to keep you comfortable, clean, and torment free (in possible), then the checkbox that corresponds with this declaration puts the quality of life as the main concern of your clinical inclinations should be selected.
21. Your Additional Instructions. You can give guidelines in regards to the degree of medical care that you desire doctors in Maine to apply when you are experiencing an ailment that is serious and fatal and to additionally characterize your determination above.
22. Name Of Primary Physician. As it is generally, Medical Providers and personnel in Maine that are going to be attending to you will try to get enough details with respect to your clinical record and present health status. As the case may be, the contact details that will be required to appropriately identify and contact your main doctor in Maine should be duly supplied.
23. Address And Phone.
24. Name And Contact For Additional Physician. There could be serious consequences on the off chance that your Maine doctor rejects a plea to talk about your condition or is inaccessible when details on your condition are required. The person may, for example, be going to an important operation or basically away and inaccessible for a critical period of time. It should be ensured that Physicians in Maine can be able to reach another Medical Personnel who knows about your record and condition in the future, and this can be done by supplying and documenting the complete name and the contact information of the secondary physician.
25. Nurse Practitioner Or Physician Assistant. Many Hospitals, which include Private Institutions, will utilize their Assistants to Physicians or Nurses to be the main point of contact with other Patients and Hospitals. In case there are Assistants to Physicians or Nurses who know about your medical condition and assist the Physician that administers treatment to you, then you might identify them to be contacted by their full name, residential and work address, and telephone number. It is encouraged that you have consent to utilize one or more of the Medical Personnel listed above as a resource and reference prior to introducing their details to this segment. While this isn't required, it is viewed as an important graciousness.
Select Item 26 Or 27
26. Opting Out Of Organ Donation. The choice on the donation of organs and other gifts that are anatomical in Maine, given upon death, can be recorded in this segment. Your refusal to be a donor of the organ in Maine if you don't wish to be a donor of the organ in Maine should be shown by ticking the checkbox of the first declaration
27. Approving An Organ Donation. Assuming the Principal in Maine desires to donate organs in Maine, then, at that point, an optional segment introduced in this document can be used for this kind of proclamation. To take care of this space the Principal in Maine should utilize the checkbox decisions to characterize on the off chance that the person wishes to give their body in general to a single individual, any required parts of the body, or organs, or give a rundown of the parts of the body (bone, organs, tissues, and so on) that are endorsed for anatomical gifts.
28. Attaching An Authorized Purpose For Organ Donation. It is essential that your choice on why a donation of organs or gifts that are anatomical ought to be given should likewise be recorded. Being the Organ Donor in the state of Maine, you can endorse anatomical gifts to be given uniquely for transplant, restorative, or purposes that are therapeutic and additionally for study and research. On the off chance that plans have been made to give parts of your body, tissues, or organs to a Clinical Institution, Professional, or Hospital, then, at that point, a documentation of the name and current address of this entity should be duly supplied. You may likewise utilize this blank to name the Recipients of the Anatomical gifts that you want to accept your parts of your body, tissues, or organs for research and education.
29. Delivering Custody Of Your Body. The location of your body upon death can likely be chosen by you, the Principal in Maine giving this directive. If it has been chosen and plans have been made that a particular individual or institution should assume responsibility for your body after your demise, then, at that point, this declaration should be made by denoting the checkbox given and the full contact details and name of this Recipient should be duly recorded.
30. Laying Out Specific Wishes For Post-Death Arrangements. There might be explicit objectives or desires with respect to your body after death. In this situation, you can be in charge of your own body upon your demise nonetheless, you should ensure that the plans that are on the ground are solid and stay so after your death. Whenever the plans for your body after death have been executed, your after-demise orders that should be executed in Maine should be recorded directly in the space given.
31. Sign Your Name. The report requires a signature that can be verified to be given by the Principal in Maine. This implies the signature the individual gave should be appended to a particular scheduled date that has been given previously with two observers present at least. The Principal in Maine should deliver the date they signed not long prior to executing this report.
32. Print Your Name.
33. Date Your Signature. The date your signature was put on this form should be recorded accordingly.
34. Your Address
35. First Witness' Signature. The signature given by the Declarant in Maine ought to be checked in order to determine its authenticity. For this to be possible, two Witnesses ought to be present to observe the Declarant in Maine as the individual in question put his signature on the document. After signing, the First Witness should peruse the assertion carefully, examining the Principal’s signature then, at that point, sign their name. Note the present schedule date will likewise be expected of the First Witness and ought to be identical to the date of the signature of the Declarant.
36. First Witness Printed Name And Signature Date.
37. First Witness Address.
38. Second Maine Witness Signature. The other Witness (witness number two) that is present ought to likewise survey the given document with respect to the Principal in Maine's signature then, at that point, upon understanding, sign their name and record the present date.
39. Second Maine Witness Printed Name And Signature Date.
40. Second Maine Witness Address.
41. Notarization Of Signature. As referenced, having a public legal (notary) official witness then authenticate the demonstration of you signing this directive as the Declarant in Maine executing the order isn’t compulsory in Maine. Many states anyway require this prerequisite for carrying out these sorts of clinical choices, consequently, it is suggested that you acquire a Public legal (Notary) official to sign this form so that the final segment of this form can be completed by him or her. If by chance just Witnesses are to be utilized to confirm your signature, then, at that point, the "Notary Acknowledgement" segment might be left untouched.
42. Maine Declarant Name. In the event that you have chosen to give a Do-Not-Resuscitate order in Maine, so that the first Responders and Medical Staff that will attend to you do not restart the heart or lungs utilizing cardiopulmonary resuscitation (CPR) then, at that point, the last section of this form should be utilized. Your complete name should be supplied as it is required in this declaration.
43. Determine An Expiration Date. The order to forgo reviving the lungs and heart that have stopped functioning will quite often bring about death or serious long-term consequences on any recuperation made. In Maine, the pronunciation that this directive will stay basically until you deny it or if it ought to terminate starting at a specific time as it will not address your desires anymore can be made. Denote the declaration that best characterizes your expectation and ensure to supply the termination date (if pertinent) that will show when this directive ends. Remember, that if you put a date of termination, doctors in Maine will endeavor to give cardiopulmonary revival to reboot your lungs and heart within the date of termination.
44. Maine Declaring Patient Signature. You are required to put your signature on this document as well as the signature of the Maine doctors in order for it to be utilized. Maine Emergency Professional will probably give CPR in case there are inquiries in regards to carrying out the directives on this document.
45. Date Signed.
46. Medical Professional Signature Requirement. A doctor in Maine should ensure that the Principal has a sensible comprehension of cardiopulmonary resuscitation and make sure the individual in question supports the choice to reject CPR by putting a signature on this form.
47. Date Signed.
48. Printed Name.
49. Telephone Number.
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