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Maine name of second witness) ______________________________________________________________________ (address of second witness) 4 __________ (signature of second witness) ______________________________________________________________________ (date) ______________________________________________________________________ (printed_______ (printed name of first witness) ______________________________________________________________________ (address of first witness) ____________________________________________________________________________________ (signature of first witness) ______________________________________________________________________ (date) 3 ________________________________________________________________ (social security number - optional) (date) ______________________________________________________________________ (signature) SIGNATURES OF WITNESSES ______________________________________________________________________________________ (name) ______________________________________________________________________ (address) ___________________________________________________________________________________________________________ (phone) (13) EFFECT OF COPY: A copy of this form has the same effect as the original. (14) SIGNATURE Sign and date the form here: ________________________________________________________________________________________ (address) ______________________________________________________________________ (city) (state) (zip code) ________________________________e to act as my primary physician, I designate the following physician as my primary physician:: ______________________________________________________________________ (name of physician) ____________ity) (state) (zip code) ______________________________________________________________________ (phone) (Optional) If the physician I have designated above is not willing, able or reasonably availabl____________________ (name of physician) ______________________________________________________________________ (address) 2 ______________________________________________________________________ (cpy (iii) Research (iv) Education PART 3 DESIGNATION OF PRIMARY PHYSICIAN (Optional) (12) I designate the following physician as my primary physician: __________________________________________________EATH (10) UPON MY DEATH: ___ I give any needed organs, tissues or parts, or ___ I give only the following organs, tissues or part: (11) MY GIFT IS FOR THE FOLLOWING PURPOSES: (i) Transplant (ii) Theraleviation of pain or discomfort be provided at all times, even if it hastens my death. 1 (4) OTHER HEALTH CARE INSTRUCTIONS OR WISHES: (add additional pages if needed) PART 2 DONATION OF ORGANS AT D__ I do want artificial nutrition and hydration provided to me in order to prolong my life. (3) RELIEF FROM PAIN OR DISCOMFORT: Except as I state in the following space, I direct that treatment for alNUTRITION AND HYDRATION: I also specify that under the conditions mentioned in the above paragraph: ____ I do not want artificial nutrition and hydration provided to me in order to prolong my life. __ment would outweigh the expected benefits, OR Choice To Prolong Life: I want my life to be prolonged as long as possible within the limits of generally accepted health care standards. (2) ARTIFICIAL t in my death within a relatively short time, (ii) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness or (iii) the likely risks and burdens of treatdraw treatment in accordance with the choice I have marked below: Choice Not To Prolong Life: I do not want my life to be prolonged if (i) I have an incurable or irreversible condition that will resulorm. ____________________________________ PART 1 INSTRUCTIONS FOR HEALTH CARE (1) END-OF-LIFE DECISIONS: I direct that my health care providers and others involved in my care provide, withhold or withform also lets you express your wishes regarding donation of organs and the designation of your primary physician. You may complete or modify all or any part of the following form or use a different fd use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Maine Living Will EXPLANATION You have the right to give instructions about your own health care. This al attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. [_] The purchase ante to state. These forms should only be a starting point for you and should not be used or signed without consulting an attorney first to make sure it fits your particular situation. Advice from a locity for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from staMaine Living Will Information This package contains the Maine Living Will. [_] These forms are provided "as is" and no implied or express warranties have been made or are provided as to their suitabil Maine