Maine Advance Directive

Information you will need

• Agent Name
• Agent Street Address
• Agent City, State, ZIP Code
• Agent Home Telephone Number
• Agent Work Telephone Number
• Successor Agent Name
• Successor Agent Street Address
• Successor Agent City, State, ZIP Code
• Successor Agent Home Telephone Number
• Successor Agent Work Telephone Number
• Effective Date of Authority
• Life Prolonging Treatment
• Incurable / Irreversible Condition
• Unconscious
• Burden of Treatment
• Other
• Other Description
• Artificial Nutrition and Hydration
• Excluded Authority
• Other Instructions: Life Prolonging Treatment
• Other Instructions: Nutrition & Hydration
• Pain Relief
• Pain Relief Circumstance
• Other Insructions

…and 40 more fields in the PDF.

Completed by the agent.

The form includes a notary acknowledgment, a witness section.