Indiana Living Will Form

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Updated on June 12th, 2023

The Indiana Living Will elucidates one’s wishes regarding medical intervention when incapacitated and facing life-ending circumstances. Basically, the instrument comes equipped with a default clause stating that if their physician deems that death is inevitable, that there will be no medical procedures performed to prolong their life, only treatments that will provide comfort and alleviate pain. In addition, the declarant can indicate whether or not they wish to receive artificially supplied nutrition & hydration, or if they accomplished a medical power of attorney, they can stipulate that their representative make that decision for them. After stating your preferences within the form, the declarant must endorse the document while being witnessed by at least two (2) qualified individuals.

Other Versions (4)

Indiana University Health Version (also available in Spanish/en Español)

Download: Adobe PDF

 

 

 


Parkview Health Version

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Reid Health Version

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Spanish/Español Version

Download: Adobe PDF, MS Word (.docx)

 

 

 

Additional Resources

Related Forms (6)

Advance Directive (Medical POA & Living Will)

Download: Adobe PDF, MS Word (.docx)

 

 

 


DNR Order (Form 49559)

Download: Adobe PDF
Laws: § 16-36-5

 

 


Durable (Financial) Power of Attorney

Download: Adobe PDF, MS Word (.docx)

 

 

 


Life-Prolonging Procedures Declaration (Form 55315)

Download: Adobe PDF, MS Word (.docx)
IUH Version: Adobe PDF
Spanish Version: Adobe PDF
Laws: § 16-36-4-11

 


Organ Donation Form

Download: Adobe PDF

 

 

 


Physician Orders for Scope of Treatment – POST (Form 55317)

Download: Adobe PDF, MS Word (.docx)
Laws: § 16-36-6