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ROBERT L. EHRLICH, JR., Governor Ch. 522
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CAN NO LONGER DECIDE FOR MYSELF. MY STATED PREFERENCES ARE
MEANT TO GUIDE WHOEVER IS MAKING DECISIONS ON MY BEHALF AND
MY HEALTH CARE PROVIDERS, BUT I AUTHORIZE THEM TO BE FLEXIBLE IN
APPLYING THESE STATEMENTS IF THEY FEEL THAT DOING SO WOULD BE
IN MY BEST INTEREST.
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((OR))
2. I REALIZE I CANNOT FORESEE EVERYTHING THAT MIGHT HAPPEN AFTER I
CAN NO LONGER DECIDE FOR MYSELF. STILL, I WANT WHOEVER IS
MAKING DECISIONS ON MY BEHALF AND MY HEALTH CARE PROVIDERS TO
FOLLOW MY STATED PREFERENCES EXACTLY AS WRITTEN, EVEN IF THEY
THINK THAT SOME ALTERNATE IS BETTER
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PART III: SIGNATURE AND WITNESSES
BY SIGNING BELOW AS THE DECLARANT, I INDICATE THAT I AM EMOTIONALLY AND
MENTALLY COMPETENT TO MAKE THIS ADVANCE DIRECTIVE AND THAT I
UNDERSTAND ITS PURPOSE AND EFFECT. I ALSO UNDERSTAND THAT THIS
DOCUMENT REPLACES ANY SIMILAR ADVANCE DIRECTIVE I MAY HAVE COMPLETED
BEFORE THIS DATE.
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(SIGNATURE OF DECLARANT) (DATE)
THE DECLARANT SIGNED OR ACKNOWLEDGED SIGNING THIS DOCUMENT IN MY
PRESENCE AND, BASED UPON PERSONAL OBSERVATION, APPEARS TO BE
EMOTIONALLY AND MENTALLY COMPETENT TO MAKE THIS ADVANCE DIRECTIVE.
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(SIGNATURE OF WITNESS) (DATE)
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TELEPHONE NUMBER(S)
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(SIGNATURE OF WITNESS) (DATE)
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TELEPHONE NUMBER(S)
(NOTE: ANYONE SELECTED AS A HEALTH CARE AGENT IN PART I MAY NOT BE A
WITNESS. ALSO, AT LEAST ONE OF THE WITNESSES MUST BE SOMEONE WHO WILL
NOT KNOWINGLY INHERIT ANYTHING FROM THE DECLARANT OR OTHERWISE
KNOWINGLY GAIN A FINANCIAL BENEFIT FROM THE DECLARANT'S DEATH.
MARYLAND LAW DOES NOT REQUIRE THIS DOCUMENT TO BE NOTARIZED.)
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- 2591 -
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