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INDIANA LIFEPROLONGING PROCEDURES DECLARATION PAGE 1 OF 1 DECLARATION B TO REQUEST THE USE OF LIFEPROLONGING PROCEDURES INSTRUCTIONS PRINT THE DATE PRINT YOUR NAME Declaration made this day of. (day)

How to fill out indiana life-prolonging procedures declaration

How to fill out Indiana life-prolonging procedures declaration:

1. Start by obtaining the necessary forms: To fill out the Indiana life-prolonging procedures declaration, you will need to obtain the appropriate forms from the Indiana State Department of Health or your healthcare provider. These forms can usually be found online or requested in person.
2. Provide personal information: Begin by providing your personal information on the form, including your full name, date of birth, address, and contact information. This ensures that the declaration is properly identified and attributed to you.
3. Appoint a healthcare representative: In the declaration, you may have the option to appoint a healthcare representative, also known as a healthcare proxy or power of attorney. This individual will have the authority to make medical decisions on your behalf if you become unable to do so.
4. Specify your preferences: Indicate your preferences regarding life-prolonging procedures in the declaration. This may include your wishes for resuscitation, artificial nutrition and hydration, mechanical ventilation, and other medical interventions. Be as specific as possible to ensure that your healthcare providers understand your desires.
5. Consider your values and beliefs: Take the time to reflect on your values and beliefs regarding end-of-life medical treatments. Consider consulting with your loved ones, clergy, or healthcare professionals to understand the options and implications fully.
6. Sign and date the document: After completing the declaration, review it carefully to ensure accuracy and clarity. Once you are satisfied, sign and date the document in the presence of two witnesses who are not related to you and who are of legal age.

Who needs Indiana life-prolonging procedures declaration:

1. Anyone who wants to have a say in their end-of-life medical treatment: The Indiana life-prolonging procedures declaration is essential for individuals who want to ensure that their healthcare preferences are known and respected. By completing this document, you can outline your wishes for medical interventions in case you are unable to communicate them later.
2. Individuals with specific medical conditions: Those with chronic illnesses or medical conditions that may require life-prolonging procedures should consider completing the declaration. It allows them to express their desires regarding the extent of medical intervention they want to receive and avoids any potential conflicts between family members or healthcare providers later on.
3. Aging individuals: As people age, it becomes increasingly important to plan for future healthcare decisions. By completing the Indiana life-prolonging procedures declaration, older adults can have peace of mind knowing that their preferences will be honored and followed.
4. Individuals approaching important medical procedures: If you are scheduled for a surgery or any medical procedure that carries risks and potential complications, it is wise to have a completed declaration in place. This ensures that in the event of unforeseen circumstances, your healthcare providers are aware of your desires and can act accordingly.

Note: It is recommended to consult with an attorney or healthcare professional to ensure that the Indiana life-prolonging procedures declaration is completed accurately and adheres to all legal requirements.

For pdfFiller’s FAQs

What is indiana life-prolonging procedures declaration?

The Indiana life-prolonging procedures declaration is a legal document that allows individuals to specify their preferences regarding life-prolonging medical treatments in the event they are unable to communicate their wishes.

Who is required to file indiana life-prolonging procedures declaration?

Any competent adult in Indiana can choose to file a life-prolonging procedures declaration.

How to fill out indiana life-prolonging procedures declaration?

To fill out an Indiana life-prolonging procedures declaration, the individual must discuss their preferences with their healthcare provider, complete the necessary form, and have it signed and witnessed.

What is the purpose of indiana life-prolonging procedures declaration?

The purpose of the Indiana life-prolonging procedures declaration is to ensure that an individual's wishes regarding life-prolonging treatments are respected and followed in the event they are unable to make decisions for themselves.

What information must be reported on indiana life-prolonging procedures declaration?

The Indiana life-prolonging procedures declaration typically includes information about the individual's preferences for CPR, ventilator use, feeding tubes, and other life-prolonging treatments.

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