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.
Laws – IC 16-36-4-11
Signing Requirements – Two (2) witnesses or a notary public (IC 16-36-4-8).
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