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Advance Directive Form

Click the button below to fill out your advance directive. You can fill this out by hand or complete it on your computer by typing in the boxes. Either way you must print it and sign it by hand. Once completed and signed, please share a copy with your primary care provider, healthcare proxy, hospital and any loved ones who you want to have this information.

Advance Care Planning

What is an Advance Directive?

Under Maine law, the term “advance directive” means any spoken or written instructions you give about the health care you want if a time comes when you are too ill to decide. Should you become too ill to make choices about your care, an advance directive will let others know which treatments/interventions you want and which you do not.

A health care Advance Directive can give you and your family peace of mind. Documenting your health care wishes spares loved ones the burden of making tough end of life decisions.

Advance directives allow for many choices. By completing an advance directive, you can identify treatments you want/don’t want, state your wishes about donating your body, organs and/or tissues at death, outline your wishes about burial and funeral arrangements, and even state your wishes about resuscitation.

Why do I need an Advance Directive?

Even if you’re in good health, it’s still important to make sure your health care team knows your wishes, since anyone’s health status can change suddenly. Don’t wait until there’s a crisis. And don’t wait for your doctor to bring it up. It always seems too early… until it’s too late. Here are key points about Advance Directives:

  • Advance directive laws vary from state to state.
  • In Maine, anyone 18 years of age or older may use the Maine Health Care Advance Directive form (if you are younger than 18, you may also be able to use an advance directive under certain limited conditions).
  • You can get help filling out an advance directive…at no cost to you.
  • You have the right to change or cancel a health care advance directive at any time.
  • Your physician generally must follow the choices in your advance directive.
  • You can choose the time when your health care advance directive takes effect (this can either be right away, or you may choose to have it only take effect when you become too sick to make decisions for yourself).
  • A health care advance directive does not take away your rights as a patient.
  • A health care advance directive does not apply to your money or property.

Who is a Health care Proxy?

Your proxy might be a family member, a friend, your lawyer, or someone from your church or place of worship.

  • Think about people you know who share your views and values about life and medical decisions.
  • You can decide how much authority your proxy has over your medical care—whether he or she is entitled to make a wide range of decisions or only a few specific ones.
  • It’s a good idea to name an alternate proxy as well. You should discuss this with those you choose before you name them officially.

Questions? Here Are Some Answers

Advance care planning is an important step, regardless of whether you are ill or in good health. The following are some common questions you may have now about advance care planning and ensuring you get the medical care you would want, if you were too ill to express those decisions on your own. You can also visit out Advance Directive FAQ page for more information.

Advance care planning is not just about old age. At any age, a medical crisis could leave someone too ill to make his or her own health care decisions.

Your decisions about how to handle any of these situations may be different at age 40 than at age 85.

Or, they may be different if you have an incurable condition as opposed to being generally healthy.

Advance care planning is a process, and at any time you can change the instructions as you get older or if your viewpoint changes.


The first step to the planning process is to talk with your primary care provider. Requirements for completing an advance directive vary by state.

Give copies of your plan to your health care proxy and alternate proxy. Give your doctor a copy for your medical records. Tell key family members and friends where you keep a copy. If you have to go to the hospital, give staff there a copy to include in your records. It’s a good idea to keep track of who receives a copy so you can provide them with an updated document if you change your advanced care plan.


Thinking about your end of life wishes can seem scary.  One big step you can take in advance care planning is to talk to your loved ones about the kind of care you want for the end of your life. Sharing your thoughts and wishes lets others know about your preferences, making it easier for them to make decisions about your care.

Learn more:

Talking to Your Loved Ones about Your Advanced Directive