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Indiana Life-Prolonging Procedures Form

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Indiana Life-Prolonging Procedures Form

Updated September 12, 2023

An Indiana life-prolonging procedures will declaration gives official notice to any medical staff treating the patient their intentions of doing everything necessary to prolong their life. This is a form unique to Indiana to help safeguard an individual from having anyone else speak on their behalf in an attempt to end their life.

Related Forms

Medical Power of Attorney (Form 56184) – Allow someone else to make medical decisions on your behalf.

Download: PDF




Living Will Declaration (Form 55316) – To select end-of-life procedure options such as terminating food and hydration in the case of a terminal illness.

Download: PDF, MS Word, OpenDocument