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  • In State Form 56184 2016

Get In State Form 56184 2016-2025

Or Information Patient Last Name Patient First Name Patient Middle Initial Patient Birthday (mm/dd/yyyy) Medical Record Number of Healthcare Facility or Provider (optional) Healthcare Facility or Provider (optional) Appointment of Health Care Representative I, being at least eighteen (18) years of age, of sound mind, and capable of consenting to my health care, hereby appoint the person(s) named below as my lawful health care representative in all matters affecting my health care, includin.

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An Indiana medical power of attorney, also known as “Form 56184”, is used to appoint a healthcare representative to make medical decisions for the principal in the event of their incapacitation.

Section 16-36-7-1 - General provisions (a) A death as a result of the withholding or withdrawal of life prolonging procedures in ance with: (1) a declarant's advance directive; or (2) any provision of this chapter; does not constitute a suicide.

Indiana Code § 16-36 allows any member of your immediate family (meaning your spouse, parent, adult child, brother, or sister) or a person appointed by a court to make the choice for you.

What is an Indiana Medical Power of Attorney? An Indiana Medical Power of Attorney is a legal document that grants a trusted person the authority to make healthcare decisions on your behalf, such as accepting or refusing certain medical treatments and procedures, when you cannot do so.

An Indiana medical power of attorney, also known as “Health Care Representative Appointment,” grants power to one person (a “health care representative”) to make medical decisions on another person's (a “principal”) behalf if the latter is incapable of doing so for themselves.

A health care representative is someone you choose to make medical decisions for you if you cannot. What form should I use? Health care representative forms are available in English and Spanish on the Indiana State Department of Health website.

A healthcare representative, like a healthcare agent is a person one may appoint to make medical decisions for them should a time come when they cannot make medical decisions for themselves. This document can be very advantageous at the right time.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232