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<section article="ghg" article_name="Health - General" number="5-608.1" title_number="5" title_name="Death" subtitle_number="6" subtitle_name="Health Care Decisions Act">
  <level label="a">
    <text>In this section, “health care facility” means:</text>
    <level label="1">
      <text>An assisted living program;</text>
    </level>
    <level label="2">
      <text>A home health agency;</text>
    </level>
    <level label="3">
      <text>A hospice;</text>
    </level>
    <level label="4">
      <text>A hospital;</text>
    </level>
    <level label="5">
      <text>A kidney dialysis center; or</text>
    </level>
    <level label="6">
      <text>A nursing home.</text>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <level label="i">
        <text>The Department, in conjunction with the Maryland Institute for Emergency Medical Services Systems and the State Board of Physicians, shall develop and revise periodically a “Medical Orders for Life–Sustaining Treatment” form and instructions for completing and using the form.</text>
      </level>
      <level label="ii">
        <text>The “Medical Orders for Life–Sustaining Treatment” form and the instructions for its completion and use shall be developed in consultation with:</text>
        <level label="1">
          <text>The Office of the Attorney General;</text>
        </level>
        <level label="2">
          <text>The State Board of Nursing;</text>
        </level>
        <level label="3">
          <text>The State Advisory Council on Serious Illness Care; and</text>
        </level>
        <level label="4">
          <text>Any other individual or group the Department determines is appropriate.</text>
        </level>
      </level>
    </level>
    <level label="2">
      <text>The “Medical Orders for Life–Sustaining Treatment” form developed under paragraph (1) of this subsection shall be suitable for containing a physician’s, physician assistant’s, or nurse practitioner’s written medical orders relating to a patient’s medical condition, including:</text>
      <level label="i">
        <text>The use of life–sustaining procedures;</text>
      </level>
      <level label="ii">
        <text>The use of medical tests;</text>
      </level>
      <level label="iii">
        <text>Transfer of the patient to a hospital from a nonhospital setting; and</text>
      </level>
      <level label="iv">
        <text>Any other matter considered appropriate by the Department to implement treatment preferences and orders regarding life–sustaining treatments across health care settings.</text>
      </level>
    </level>
    <level label="3">
      <text>The “Medical Orders for Life–Sustaining Treatment” form is not an advance directive.</text>
    </level>
  </level>
  <level label="c">
    <level label="1">
      <text>A health care facility shall:</text>
      <level label="i">
        <level label="1">
          <text>Accept a completed “Medical Orders for Life–Sustaining Treatment” form during the admission process for each patient being admitted to the health care facility; and</text>
        </level>
        <level label="2">
          <text>Update the form as indicated in the instructions for the completion and use of the form; or</text>
        </level>
      </level>
      <level label="ii">
        <text>Complete a “Medical Orders for Life–Sustaining Treatment” form:</text>
        <level label="1">
          <text>For a health care facility that is not a hospital, during the admission process for each patient being admitted to the health care facility; or</text>
        </level>
        <level label="2">
          <text>For a hospital, during an inpatient hospital stay for patients who are being discharged to another health care facility.</text>
        </level>
      </level>
    </level>
    <level label="2">
      <text>When a health care facility updates or completes a “Medical Orders for Life–Sustaining Treatment” form under paragraph (1) of this subsection, the health care facility shall:</text>
      <level label="i">
        <text>Offer the patient, health care agent, or surrogate decision maker the opportunity to participate in updating or completing the form;</text>
      </level>
      <level label="ii">
        <text>Note in the medical record when a patient, health care agent, or surrogate decision maker declines to participate in updating or completing the form, indicating the date and with whom the form was discussed;</text>
      </level>
      <level label="iii">
        <text>On request of the patient, offer any physician, physician assistant, or nurse practitioner selected by the patient the opportunity to participate in updating or completing the form; and</text>
      </level>
      <level label="iv">
        <text>Inform the patient, health care agent, or surrogate decision maker that the form will become a part of the patient’s medical record and can be accessed through the procedures used to access a medical record.</text>
      </level>
    </level>
    <level label="3">
      <text>Except as provided for a treatment that has been certified as medically ineffective in accordance with § 5–611 of this subtitle, the “Medical Orders for Life–Sustaining Treatment” form shall be consistent with:</text>
      <level label="i">
        <text>The known decisions of:</text>
        <level label="1">
          <text>The patient if the patient is a competent individual; or</text>
        </level>
        <level label="2">
          <text>A health care agent or surrogate decision maker as authorized by this subtitle; and</text>
        </level>
      </level>
      <level label="ii">
        <text>Any known advance directive of the patient if the patient is incapable of making an informed decision.</text>
      </level>
    </level>
  </level>
  <level label="d">
    <level label="1">
      <text>A health care provider other than a health care facility may choose to use a “Medical Orders for Life–Sustaining Treatment” form.</text>
    </level>
    <level label="2">
      <text>A health care provider who chooses to use a “Medical Orders for Life–Sustaining Treatment” form shall offer a patient, health care agent, or surrogate decision maker the opportunity to participate in the completion of the form.</text>
    </level>
  </level>
  <level label="e">
    <text>The original or a copy of a “Medical Orders for Life–Sustaining Treatment” form shall:</text>
    <level label="1">
      <text>Be kept by a health care provider in the patient’s medical record;</text>
    </level>
    <level label="2">
      <text>Physically accompany the patient or be transmitted electronically or by facsimile in accordance with the instructions for the use of the form when the patient is transferred to a health care facility; and</text>
    </level>
    <level label="3">
      <text>Be given to the patient, health care agent, or surrogate decision maker within 48 hours of completion of the form or sooner if the patient is transferred or discharged.</text>
    </level>
  </level>
  <level label="f">
    <text>Except as provided in § 5–611 or § 5–613 of this subtitle, a health care facility shall comply with all medical orders contained in a “Medical Orders for Life–Sustaining Treatment” form regardless of whether the physician, physician assistant, or nurse practitioner who signed the form has admitting privileges or is otherwise credentialed at the health care facility.</text>
  </level>
  <level label="g">
    <text>In the event of a conflict between more than one “Medical Orders for Life–Sustaining Treatment” form, the most recent form shall be followed.</text>
  </level>
  <level label="h">
    <text>A health care provider may rely in good faith on the presumed validity of a “Medical Orders for Life–Sustaining Treatment” form.</text>
  </level>
  <level label="i">
    <level label="1">
      <text>The Department shall adopt regulations that specify the “Medical Orders for Life–Sustaining Treatment” form and the instructions for the completion and use of the form that are developed as required by subsection (b) of this section, including instructions on how a “Medical Orders for Life–Sustaining Treatment” form is revised or revoked.</text>
    </level>
    <level label="2">
      <text>Regulations adopted under paragraph (1) of this subsection shall be consistent with the Health Care Decisions Act.</text>
    </level>
  </level>
  <level label="j">
    <text>The Department shall make the “Medical Orders for Life–Sustaining Treatment” form and the instructions for the completion and use of the form, including instructions on how the form is revised or revoked, available on its website and may print and distribute the form, the instructions, and training materials.</text>
  </level>
</section>
