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This version of the form is not currently in use and is provided for reference only. Download this version of
Form MAID-6
for the current year.
Form MAID-6 Request for Medication to End My Life in a Humane and Dignified Matter - New Jersey
What Is Form MAID-6?
This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form MAID-6?
A: Form MAID-6 is a request for medication to end one's life in a humane and dignified manner in New Jersey.
Q: What does MAID stand for?
A: MAID stands for Medical Aid in Dying.
Q: Who can use Form MAID-6?
A: Only New Jersey residents who are terminally ill and have a prognosis of six months or less to live can use Form MAID-6.
Q: What is the purpose of Form MAID-6?
A: The purpose of Form MAID-6 is to request medication that allows a terminally ill individual to choose to end their own life.
Q: What are the requirements to use Form MAID-6?
A: To use Form MAID-6, a person must be an adult, of sound mind, capable of making medical decisions, and have made two verbal requests to their attending physician.
Form Details:
- Released on August 1, 2019;
- The latest edition provided by the New Jersey Department of Health;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form MAID-6 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.
Download Form MAID-6 Request for Medication to End My Life in a Humane and Dignified Matter - New Jersey
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