Indiana Life Prolonging Procedures Declaration - Statutory Form
What this document covers
The Life Prolonging Procedures Declaration is a legal document that outlines your wishes regarding medical treatment in the event you encounter an incurable injury, disease, or illness classified as terminal. This form allows you to specify your preferences for life-prolonging procedures, including nutrition, hydration, medication, and other medical interventions. It is distinct from living wills and advance directives as it specifically addresses your desire for life-extending medical interventions during terminal conditions.
What’s included in this form
- Declaration date: Specifies the date the declaration is made.
- Declarantâs information: Includes the name and confirmation of sound mind.
- Request for life-prolonging procedures: Clearly states the wish for medical interventions during terminal conditions.
- Comfort care provisions: Addresses the desire for care to alleviate pain and provide comfort.
- Signature lines: Requires signatures from the declarant and witnesses to validate the document.
When to use this document
This form is vital when you want to ensure that your wishes regarding medical treatment are known and respected during critical health situations. It is typically used if you are diagnosed with a terminal condition and wish to articulate your preference for or against life-prolonging procedures, particularly if you may not be able to communicate those wishes later.
Who should use this form
- Adults aged eighteen (18) and older who are of sound mind.
- Individuals seeking to clarify their medical treatment preferences in the event of a terminal illness.
- People who want to provide guidance to their healthcare providers and family regarding their end-of-life care wishes.
Completing this form step by step
- Fill in the declaration date at the top of the form.
- Clearly state your name and confirm that you are at least eighteen years of age and of sound mind.
- Specify your requests regarding life-prolonging procedures in the designated section.
- Sign the form to validate your declaration.
- Secure signatures from at least two witnesses to confirm your sound mind and understanding.
Does this document require notarization?
Notarization is generally not required for this form. However, certain states or situations might demand it. You can complete notarization online through US Legal Forms, powered by Notarize, using a verified video call available anytime.
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
Mistakes to watch out for
- Failing to have the required number of witnesses sign the form.
- Not dating the declaration, which can lead to questions about its validity.
- Leaving areas of the form blank, which may create ambiguity about your wishes.
Why complete this form online
- Convenient access: Download the form anytime, eliminating the need for in-person visits.
- Editability: Ensure that your preferences are accurately captured and easily updated as needed.
- Reliable: Use professionally drafted forms created by licensed attorneys ensuring legal compliance.
What to keep in mind
- The Life Prolonging Procedures Declaration allows you to communicate your health care wishes.
- It is crucial to ensure that the form is properly completed and signed by witnesses.
- This form should be reviewed periodically to ensure that it reflects your current wishes.
