Get Indiana Out Of Hospital - Do Not Resuscitate Declaration - Dnr - Statutory Form

The Indiana Out Of Hospital - Do Not Resuscitate Declaration - DNR - Statutory Form is an important document that allows individuals to express their wishes regarding resuscitation in an out-of-hospital setting. This guide will walk you through the process of completing this form online to ensure your desires are clearly communicated.

Follow the steps to fill out the form accurately and effectively.

1. Begin by clicking the ‘Get Form’ button to access the Indiana Out Of Hospital - Do Not Resuscitate Declaration - DNR - Statutory Form and open it in your preferred editing tool.
2. In the first section of the form, fill in the date on which you are completing the document. This should be done on the line labeled 'Declaration made this ____ day of.'
3. Complete the declaration by inserting your full name where indicated. You must be of sound mind and at least eighteen years of age to execute this form.
4. Indicate your wishes regarding resuscitation by confirming that your attending physician has certified you as a qualified person. This typically means you have a terminal condition or a serious medical situation.
5. State your directive regarding the withholding of cardiopulmonary resuscitation in an out-of-hospital setting. This ensures your wish to die naturally is respected.
6. Acknowledge and confirm your understanding of your right to revoke the declaration at any time by signing, dating, or communicating your decision to healthcare providers.
7. Sign the document in the designated space to formally indicate your acceptance of the contents of the declaration.
8. Print your name, provide your address, and state your city and state of residence in the respective fields.
9. Engage witnesses to the declaration. Two witnesses must sign, with their printed names and the dates of signing included. Ensure they meet the requirements outlined in the declaration.
10. The attending physician should fill out their section, including their signature, printed name, and medical license number to validate the declaration.
11. Review the completed form for accuracy, and ensure all fields are filled in correctly before saving your changes, downloading or printing your copy for personal records.

Take action today by completing your Indiana Out Of Hospital - Do Not Resuscitate Declaration - DNR - Statutory Form online.