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Reset Form INDIANA LIVING WILL DECLARATION State Form 55316 (6-13) Indiana State Department of Health IC 16-36-4 This declaration is effective on the date of execution and remains in effect until.

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How to fill out the Living Will Declaration online

Creating a Living Will Declaration is an important step in ensuring that your medical preferences are respected during critical times. This guide will walk you through the online process of filling out the form effectively and confidently.

Follow the steps to complete your Living Will Declaration online.

  1. Click ‘Get Form’ button to access the Living Will Declaration form and open it in your preferred editor.
  2. Begin by entering the date of your declaration. This is the specific day you are completing the form.
  3. Provide your full name in the space provided. Ensure that all information is accurate as this will identify you as the declarant.
  4. Confirm that you are at least eighteen (18) years of age and of sound mind to make this declaration by marking the appropriate box.
  5. Read through the conditions under which life prolonging procedures may be withheld, which require certification from your attending physician.
  6. Indicate your preferences regarding artificially supplied nutrition and hydration by initialing or marking your choice in the provided spaces.
  7. Make a note of who your health care representative or attorney in fact is, should you choose to leave the decision of nutrition and hydration to them.
  8. Review the entire declaration for accuracy and clarity to ensure your intentions are clearly expressed.
  9. Sign and date the declaration in the designated area, ensuring you also indicate the city, county, and state of your residence.
  10. Identify two witnesses who meet the requirements stated in the form, and have them sign and date the document as well.
  11. Once all fields are completed, save the changes, download the completed form, print it out, or share it as needed.

Complete your Living Will Declaration online today to ensure your medical wishes are honored.

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Step 1 Decide Your Treatment Options. Step 2 Choose Your End-of-Life Decisions. Step 3 Select a Health Care Agent (Optional) Step 4 Signing the Form. Step 1 Download Your Living Will. Step 2 Health Care Directive. Step 3 Life Support. Step 4 Life-Sustaining Treatment.

There is no requirement to file your will with a court during your lifetime. In fact, many people simply keep the document in a safe place and do not file it while they are still alive. However, if you choose to file the paperwork prior to your death, the probate court stores it for safekeeping.

Living will. A living will is a written, legal document that spells out medical treatments you would and would not want to be used to keep you alive, as well as your preferences for other medical decisions, such as pain management or organ donation. In determining your wishes, think about your values.

The purpose of this Living Will Declaration is to document your wish that life-sustaining treatment, including artificially or technologically supplied nutrition and hydration, be withheld or withdrawn if you are unable to make informed medical decisions and are in a terminal condition or in a permanently unconscious ...

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