An Act To Amend the Uniform Health-care Decisions Act Concerning Personal Representatives under Federal Law
Maine Legislature, Session 122, LD 1567
Committee: Judiciary
Sponsors: RICHARDSON, HOBBINS, CANAVAN, CROSBY, GLYNN, PELLETIER-SIMPSON, PINGREE, HASTINGS

Legislative Document 
No. 1567 
H.P.1105 
House of Representatives, April 12,2005 
An Act To Amend the Uniform Health-care Decisions Act 
Concerning Personal Representatives under Federal Law 
Reference to the Committee on Judiciary suggested and ordered printed. 
Presented by Speaker RICHARDSON of Brunswick. 
Cosponsored by Senator HOBBINS of York and 
1Y/~/J7.~ 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: CANAVAN of Waterville, CROSBY of Topsham, GLYNN of South 
Portland, PELLETIER-SIMPSON of Auburn, PINGREE of North Haven, Senator: 
HASTINGS of Oxford. 
Printed on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. IS-A MRSA §5-S04, Pt.l, as amended by PL 2003, c. 688, 
Pt. M, §1 and affected by §2, is further amended to read: 
PART 1 
POWER OF ATTORNEY FOR HEALTH CARE 
(1) 
DESIGNATION 
OF 
AGENT: 
I 
designate 
the 
following 
individual as my agent to make health-care decisions for me: 
· ..................................................... . 
(name of individual you choose as agent) 
· ..................................................... . 
(address) 
(ci ty) 
(state) 
(zip code) 
· ..................................................... . 
(home phone) 
OPTIONAL: 
If I revoke 
is 
not 
willing, 
able 
or 
heal th-care decision for me, 
agent: 
(work phone) 
my agent's authority or if my agent 
reasonably 
available 
to 
make 
a 
I designate as my first alternate 
(name of individual you choose as first alternate agent) 
(address) 
( city) 
(state) 
(zip code) 
(home phone) 
(work phone) 
OPTIONAL: 
If I revoke the authority of my agent and first 
alternate agent or if neither is willing, 
able or reasonably 
available to make a health-care decision for me, 
I designate as 
my second alternate agent: 
•••••••••••••••••••••••••••••••••••••.•••••••••.••••••• 
(name of individual you choose as second alternate agent) 
(address) 
(city) 
(state) 
(zip code) 
...................................................... . 
(home phone) 
(work phone) 
(2) 
AGENT'S AUTHORITY: 
My agent is authorized to make all 
health-care decisions for me, 
including decisions to provide, 
withhold or withdraw artificial nutrition and hydration and all 
Page l-LR1366(1) 
other forms of health care to keep me alive, except as I state 
here: 
(Add additional sheets if needed.) 
( 3 ) 
WHEN AGENT'S AUTHORITY BECOMES EFFECTIVE: 
My agent's 
authority becomes effective when my primary physician determines 
that I 
am unable to make my own health-care decisions unless I 
mark the following box. 
If I mark this box [ 
], my agent's 
authority to 
make health-care decisions 
for 
me 
takes effect 
immediately. 
(4) 
AGENT'S OBLIGATION: 
My agent shall make health-care 
decisions for me in accordance with this power of attorney for 
health care, any instructions I give in Part 2 of this form and 
my other wishes to the extent known to my agent. 
To the extent 
my wishes are unknown, my agent shall make health-care decisions 
for me in accordance with what my agent determines to be in my 
best interest. 
In determining my best interest, my agent shall 
consider my personal values to the extent known to my agent. 
(5) 
NOMINATION OF 
GUARDIAN: 
If a guardian of my person 
needs to be appointed for me by a court, I nominate the agent 
designated in this form. 
If that agent is not willing, able or 
reasonably available to act as guardian, I nominate the alternate 
agents whom I have named, in the order designated. 
( 6 ) 
HEALTH 
INFORMATION 
AND 
OTHER 
MEDICAL 
RECORDS: 
In 
addition to the other pow~ranted by this document, I grant to 
my 
agent 
the 
power 
and 
authority to 
serve 
as 
my 
personal 
representative for all purposes of the federal Health Insurance 
Portability and Accountability Act of 1996, 
United States 
Code, Section 1320d et seq., 
"HIPAA," and its regulations, 
Code of Federal Regulations, Section 160-164 (2004), during any 
time that my agent is exercising authority under this document. 
I intend for my agent to be treated as I would be with respect to 
my rights regarding the use and disclosure of my individually 
identifiable health information and other medical records. 
This 
release authority applies to any information governed by HIPAA. 
I 
authorize any physician, health-care professional, 
den~ 
health plan, 
hospital, 
clinic, 
laboratory, 
pharmacy or other 
~red health-care provider, 
any 
insurance 
company 
and 
any 
health-care clearinghouse that has provided treatment or services 
to me or that has paid for, or is seeking r~mbursement from me 
for, such services to give, disclose and release to my agent. 
without restriction, all of my individually identifiable health 
information and medical records regarding any past, present or 
future 
medi~al or 
mental 
n~lth condition, 
to 
include 
all 
information relating to the diagnosis and treatment of HIV/AIDS, 
sexually transmitted diseases, mental illness and drug or alcohol 
abuse. 
The authority given to my agent supersedes any prior 
a9ll~!Tlent 
that I may have made with my health-care providers to restrict 
access to or disclosure of my individually identifiable health 
information. 
The authority given to my agent has no expiration 
date and expires only in the event that I revoke the authority in 
writing and deliver it to my health-care providers. 
SUMMARY 
This bill amends the model advance health care directive 
contained in the Uniform Health-care Decisions Act to ensure that 
health care providers are not limited in the medical information 
they can provide to the patient's agent under the federal Health 
Insurance Portability and Accountability Act of 1996.