Health Information Technology   Electronic Advance Directives  


An advance directive is a useful, legal way for an individual (or declarant) to direct their medical care, particularly treatment preferences in an emergency or near end of life.  An advance directive can also include the name of a health care agent (or proxy) that can make decisions for a declarant if they are unable to do so themselves.  Maryland law permits an advance directive to be in the form of a written or electronic document or a verbal statement made in a video recording.  Increasing accessibility to advance directives has generally been a national priority in health care decision making policy to ensure patients receive medical care that is consistent with their values, goals, and preferences. Over the last several years, the State has prioritized expanding access to electronic advance directives via the State-Designated Health Information Exchange (HIE), the Chesapeake Regional Information System for our Patients (CRISP).  Refer to the background presentation in the Resources section below for more information.

State Recognition

State law (2016 Chapter 510 and 2017 Chapter 667) requires the Maryland Health Care Commission (MHCC) to develop a State Recognition Program for electronic advance directives services (also referred to as vendors).  The law aims to facilitate use of cloud-based technology that supports creation of and accessibility to electronic advance directives.  State Recognition demonstrates a vendor meets certain criteria or standards for privacy and security, independent audits, education, reporting, and technical provisions, some of which are required by State and federal law.

In the fall of 2016, MHCC collaborated with stakeholders to develop draft regulations and vendor criteria for State Recognition. COMAR 10.25.19:  State Recognition of an Electronic Advance Directives Service outlines program procedures for State Recognition, a prerequisite for connecting to the State-Designated HIE.  Vendors seeking State Recognition are required to meet all criteria. State Recognition is valid for three years, unless suspended or revoked by MHCC.

Vendor criteria for State Recognition is available hereThe application for State Recognition of an Electronic Advance Directives Services can be found here.  Questions about how to submit an application to be considered for State Recognition can be directed to Justine Springer at

The following electronic advance directives service has been granted State Recognition from MHCC:



CRISP was designated in 2009 by MHCC and the Health Services Cost Review Commission to build and maintain the technical infrastructure to support the secure exchange of electronic health information statewide.  Various provider organizations throughout Maryland are connected to CRISP, including all acute care hospitals and almost half of long-term care facilities.  Click here for more information on CRISP participating organizations.

Consumer Education

Advance Directives Information Sheet

Advance care planning is a widely recognized way to support patient self-determination, facilitate decision making, and promote better care at the end of life (AMA). Regardless of health status, everyone over the age of 18 is encouraged to think about and document their values and treatment preferences to guide future medical decisions about their care. This includes appointing a health care agent. Refer to the information sheet below to help health care consumers understand the advance care planning process and options for creating an electronic advance directive.  

*Note: The Advance Directives Information Sheet is available in two options. Both options contain the same content; the only difference is how they are formatted.  

Advance Directives Information Sheet - Option 1

Color - Download PDF

Black and White - Download PDF 

Advance Directives Information Sheet - Option 2

Color - Download PDF

Black and White - Download PDF 

Related Resources

Electronic Advance Directives - How to Share Decisions about Your Health Care

An overview of options to create, share, and update an electronic directive.

Mental Health Advance Directives

Information on mental health advance directives, including benefits, key components, and how to get started. 

Public Service Announcement:  An Important Message to Marylanders about Advance Care Planning 

Communications Toolkit

The Advance Directives Information Sheet and related resources can be used to promote advance care planning and pathways for Marylanders to create, share, and update their advance directive and health care agent information.  Refer to the Communications Toolkit for sample website language, social media posts, and images to aid in your promotion of the information sheet.

Other Resources

Viewing Mental Health Advance Directives in CRISP - Guidance for Health Care and Human Service Professionals

Information on how to participate with the State Designated Health Information Exchange (CRISP) to view advance directives. 

Chapter 297 | Senate Bill 154 (2023) Public Health – Mental Health Advance Directives – Awareness and Statewide Database:  An Update of Activities (November 2023)

Planning to build awareness of and access to mental health advance directives through the State-Designated Health Information Exchange, CRISP. 

Spotlight:  Electronic Advance Directives (August 2023)

An overview of efforts supporting diffusion of electronic advance directives in Maryland since 2011. 

Background Presentation - Electronic Advance Directives in Maryland

Provides historical context on the State’s efforts to increase accessibility to electronic advance directives.

Strategy for Implementing Electronic Advance Directives & MOLST Forms

Workgroup recommendations for increasing accessibility to electronic advance directives and MOLST forms using an HIE.

The Maryland Attorney General

Information on advance directives and available resources in Maryland.  

Summary of Maryland Health Care Decisions Act

Guidance from the Maryland Attorney General about the law as amended through 2017. 

Last Updated: 2/22/2024