Get the free Indiana Life Prolonging Procedures Declaration - Statutory Form

LIFE PROLONGING PROCEDURES DECLARATION (IC 16-36-4-11) Declaration made this day of (month, year). I, being at least eighteen (18) years of age and of sound mind, willfully and voluntarily make known

How to fill out indiana life prolonging procedures

How to Fill Out Indiana Life Prolonging Procedures:

1. Gather all necessary information and documents required for the Indiana life prolonging procedures.
2. Review and understand the instructions provided by the Indiana Department of Health or any other relevant authority.
3. Complete the personal details section accurately, including your full name, date of birth, and contact information.
4. Provide detailed information about your current medical condition, any existing illnesses or disabilities, and any medications you are currently taking.
5. Specify your preferences regarding life-prolonging treatments, such as resuscitation, mechanical ventilation, tube feeding, or other medical interventions.
6. Nominate a healthcare representative or proxy who will make decisions on your behalf if you are unable to do so.
7. Sign and date the form in the presence of a notary public or two witnesses, as required by Indiana law.
8. Make copies of the completed form for yourself, your healthcare representative, your primary physician, and any other relevant healthcare providers.
9. Update your Indiana life prolonging procedures whenever there are significant changes in your health, treatment preferences, or designated healthcare representative.

Who Needs Indiana Life Prolonging Procedures:

1. Indiana residents who are of legal age and have the capacity to make healthcare decisions.
2. Individuals who wish to document their preferences regarding life-prolonging treatment options in case of a medical emergency.
3. Those who want to appoint a healthcare representative to ensure their treatment choices are respected if they become incapacitated.
4. Patients with chronic illnesses or serious medical conditions who want to communicate their treatment preferences to healthcare providers.
5. Anyone who wishes to have their medical treatment decisions legally recognized and followed according to their expressed wishes.
6. Patients who want to relieve family members or loved ones from making difficult decisions about their medical care in challenging situations.

This is a state specific form specifying your desires if at any time you have an incurable injury, disease, or illness determined to be a terminal condition. The form is your request for the use of life prolonging procedures that would extend your life, including appropriate nutrition and hydration, the administration of medication, and the performance of all other medical procedures necessary to extend my life, to provide comfort care, or to alleviate pain.

For pdfFiller’s FAQs

What is indiana life prolonging procedures?

Indiana life prolonging procedures, also known as the Indiana Medical Orders for Scope of Treatment (MOST), is a set of legal documents that outline an individual's preferences regarding life-prolonging procedures and medical treatments at the end of their life.

Who is required to file indiana life prolonging procedures?

Indiana residents who are 18 years or older and have decision-making capacity are encouraged to complete and file the Indiana life prolonging procedures. It is particularly important for individuals with serious illness or those who want to communicate their end-of-life treatment preferences to their healthcare providers and loved ones.

How to fill out indiana life prolonging procedures?

To fill out Indiana life prolonging procedures, you can obtain the MOST form from your healthcare provider or the Indiana State Department of Health. The form requires you to provide information about your medical condition, treatment preferences, and appoint a healthcare representative if desired. It is important to discuss your preferences with your healthcare provider and loved ones before completing the form.

What is the purpose of indiana life prolonging procedures?

The purpose of Indiana life prolonging procedures is to ensure that an individual's treatment preferences and goals at the end of life are honored by healthcare providers. It provides a legal framework for making informed decisions about life-sustaining treatments, including resuscitation, mechanical ventilation, and artificial nutrition and hydration.

What information must be reported on indiana life prolonging procedures?

Indiana life prolonging procedures require individuals to report their medical condition, treatment preferences, and any specific instructions regarding life-prolonging procedures. It may also include the appointment of a healthcare representative who can make decisions on behalf of the individual if they are unable to do so.