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Indiana Life Prolonging Procedures Declaration - Statutory Form

Indiana Life Prolonging Procedures Declaration - Statutory Form

Category:

Power of Attorney - Healthcare - Living Wills

State:

Indiana

Control #:

IN-P024

Format:

Instant download

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What this document covers

The Life Prolonging Procedures Declaration is a legal document that outlines your wishes regarding medical treatment in the event of a terminal condition. It allows you to specify your desire for life prolonging procedures, including nutrition, hydration, and pain relief measures. This form is distinct from other advance directives as it focuses specifically on life extension options when facing incurable injuries or diseases. It ensures your healthcare preferences are respected when you cannot communicate them yourself.

What’s included in this form

Date of declaration
Your full name and confirmation of age and mental competency
Statement of desire for life prolonging procedures under terminal conditions
Instructions regarding nutrition, hydration, and medication
Statement of intent for family and physician compliance
Signature section for the declarant and witnesses

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When to use this form

This form is necessary when you want to ensure that your medical treatment preferences are clear in the event that you are unable to communicate due to a terminal illness or injury. It is essential for individuals who have worries about the extent of medical interventions they may receive in end-of-life situations. This declaration is useful for planning discussions with family members and healthcare providers about your values and wishes regarding life-sustaining treatments.

Who should use this form

Individuals aged eighteen (18) or older
Persons who want to exert control over their medical treatment in terminal health conditions
Individuals seeking to communicate their healthcare wishes to family and healthcare professionals
People who have specific preferences regarding life prolonging procedures

Completing this form step by step

Enter the date of declaration in the designated field.
Provide your full name and confirm that you are at least eighteen (18) years of age and of sound mind.
Clearly state your request for life prolonging procedures in the event of a terminal condition.
Include any specific instructions regarding nutrition, hydration, and medication.
Sign the document and have it witnessed by at least two individuals who are also over eighteen (18) and of sound mind.

Does this document require notarization?

This form usually doesn’t need to be notarized. However, local laws or specific transactions may require it. Our online notarization service, powered by Notarize, lets you complete it remotely through a secure video session, available 24/7.

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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.

Avoid these common issues

Failing to date the declaration accurately.
Not having the form witnessed properly.
Leaving sections blank that specify healthcare wishes.
Using language that is unclear or ambiguous in expressing desires.

Benefits of using this form online

Convenience of completing the form from home.
Easy access to downloadable templates that are legally vetted.
Ability to edit and customize the form to meet personal preferences.
Quick turnaround time, allowing for timely planning and decision-making.

Main things to remember

The Life Prolonging Procedures Declaration allows you to outline your medical treatment preferences in advance.
It is essential for individuals facing terminal conditions to have this documentation to ensure their wishes are respected.
Ensure proper completion with signatures and witness attestations to validate the form.

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Life Prolonging Procedures Declaration - Statutory Form

STATUTORY REFERENCE

ALL REFERENCES ARE TO THE INDIANA CODE

LIVING WILL DECLARATION
and
LIFE PROLONGING PROCEDURES DECLARATION
(§§ 16-36-4-1 through 16-36-4-21)

A "life prolonging procedure" is any medical procedure, treatment, or intervention that does the following:

Uses mechanical or other artificial means to sustain, restore, or supplant a vital function.

Serves to prolong the dying process.

"Life prolonging procedure" does not include the performance or provision of any medical procedure or medication necessary to provide comfort care or to alleviate pain.

A "life prolonging procedures will declarant" means a person who has executed a life prolonging procedures will declaration under §16-36-4-11.

A "living will declarant" is a person who has executed a living will declaration under §16-36-4-10.

A "qualified patient" is a patient who has been certified as a qualified patient under §16-36-4-13.

A "terminal condition" is a condition caused by injury, disease, or illness from which, to a reasonable degree of medical certainty there can be no recovery and death will occur from the terminal condition within a short period of time without the provision of life prolonging procedures.

A person who is of sound mind and is at least eighteen years of age may execute a life prolonging procedures will declaration under §16-36-4-11 or a living will declaration under §16-36-4-10.

A life prolonging procedures will declaration under or a living will declaration must meet the following conditions:

Be voluntary.

Be in writing.

Be signed by the person making the declaration or by another person in the declarant's presence and at the declarant's express direction.

Be dated.

Be signed in the presence of at least two competent witnesses who are at least eighteen years of age.

A witness to a living will declaration cannot:

Be the person who signed the declaration on behalf of and at the direction of the declarant.

Be a parent, spouse, or child of the declarant.

Be entitled to any part of the declarant's estate whether the declarant dies testate or intestate, including whether the witness could take from the declarant's estate if the declarant's will is declared invalid.

Be directly financially responsible for the declarant's medical care.

The living will declaration of a person diagnosed as pregnant has no effect during the person's pregnancy.

A declaration must be substantially in the form set forth in either §16-36-4-11 or §16-36-4-10. The invalidity of any additional, specific directions does not affect the validity of the declaration.

A living will declaration or a life prolonging procedures will declaration may be revoked at any time by the declarant by any of the following:

A signed, dated writing.

Physical cancellation or destruction of the declaration by the declarant or another in the declarant's presence and at the declarant's direction.

An oral expression of intent to revoke.

A revocation is effective when communicated to the attending physician.

If the qualified patient who executed a living will declaration is incompetent at the time of the decision to withhold or withdraw life prolonging procedures, a properly executed living will declaration is presumed to be valid.

Note: All Information and Previews are subject to the Disclaimer located on the main forms page, and also linked at the bottom of all search results.

Life Prolonging Procedures Declaration - Statutory Form

STATUTORY REFERENCE

ALL REFERENCES ARE TO THE INDIANA CODE

LIVING WILL DECLARATION
and
LIFE PROLONGING PROCEDURES DECLARATION
(§§ 16-36-4-1 through 16-36-4-21)

A "life prolonging procedure" is any medical procedure, treatment, or intervention that does the following:

Uses mechanical or other artificial means to sustain, restore, or supplant a vital function.

Serves to prolong the dying process.

"Life prolonging procedure" does not include the performance or provision of any medical procedure or medication necessary to provide comfort care or to alleviate pain.

A "life prolonging procedures will declarant" means a person who has executed a life prolonging procedures will declaration under §16-36-4-11.

A "living will declarant" is a person who has executed a living will declaration under §16-36-4-10.

A "qualified patient" is a patient who has been certified as a qualified patient under §16-36-4-13.

A person who is of sound mind and is at least eighteen years of age may execute a life prolonging procedures will declaration under §16-36-4-11 or a living will declaration under §16-36-4-10.

A life prolonging procedures will declaration under or a living will declaration must meet the following conditions:

Be voluntary.

Be in writing.

Be signed by the person making the declaration or by another person in the declarant's presence and at the declarant's express direction.

Be dated.

Be signed in the presence of at least two competent witnesses who are at least eighteen years of age.

A witness to a living will declaration cannot:

Be the person who signed the declaration on behalf of and at the direction of the declarant.

Be a parent, spouse, or child of the declarant.

Be directly financially responsible for the declarant's medical care.

The living will declaration of a person diagnosed as pregnant has no effect during the person's pregnancy.

A living will declaration or a life prolonging procedures will declaration may be revoked at any time by the declarant by any of the following:

A signed, dated writing.

Physical cancellation or destruction of the declaration by the declarant or another in the declarant's presence and at the declarant's direction.

An oral expression of intent to revoke.

A revocation is effective when communicated to the attending physician.

Note: All Information and Previews are subject to the Disclaimer located on the main forms page, and also linked at the bottom of all search results.

Indiana Life Prolonging Procedures Declaration - Statutory Form

This form is part of a form package!

What this document covers

What’s included in this form

Related forms

When to use this form

Who should use this form

Completing this form step by step

Does this document require notarization?

Get your form ready online

Avoid these common issues

Benefits of using this form online

Main things to remember

Looking for another form?

Viewed forms

Form popularity

Explore more forms

Trusted and secure by over 3 million people of the world’s leading companies

Indiana Life Prolonging Procedures Declaration - Statutory Form

This form is part of a form package!

What this document covers

What’s included in this form

Related forms

When to use this form

Who should use this form

Completing this form step by step

Does this document require notarization?

Get your form ready online

Avoid these common issues

Benefits of using this form online

Main things to remember

Looking for another form?

Viewed forms

Form popularity

Indiana Life Prolonging Procedures Declaration - Statutory Form Related Searches

Explore more forms

Trusted and secure by over 3 million people of the world’s leading companies