Last updated on Feb 20, 2026
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REVOCATION OF LIFE PROLONGING PROCEDURES DECLARATION I Declarant executed a Life Prolonging Procedures Declaration on the day of IC 16-36-4-12 provides that a living will declaration or a life prolonging procedures will declaration may be revoked at any time by the declarant by any of the following 1 A signed dated writing. 2 Physical cancellation or destruction of the declaration by the declarant or another in the declarant s presence and at the declarant s direction* 3 An oral expression of...intent to revoke. This is my written revocation as indicated above of my Declaration and is provided to all persons to whom I have provided a copy of that Declaration* DATED this the day of 20. 2 Physical cancellation or destruction of the declaration by the declarant or another in the declarant s presence and at the declarant s direction* 3 An oral expression of intent to revoke. This is my written revocation as indicated above of my Declaration and is provided to all persons to whom I have...provided a copy of that Declaration* DATED this the day of 20.
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What is revocation of life prolonging
Revocation of life prolonging is a legal document that allows an individual to withdraw previously given consent for medical treatments that extend life.
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Who needs revocation of life prolonging?
Explore how professionals across industries use pdfFiller.
Revocation of life prolonging is needed by:
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Individuals diagnosed with terminal illnesses.
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Patients experiencing severe suffering.
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Those wishing to assert their end-of-life choices.
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Family members of patients wishing to clarify medical decisions.
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Healthcare providers seeking clear directives.
Comprehensive Guide to Revocation of Life Prolonging Procedures Declaration
How to fill out a revocation of life prolonging form
Filling out a revocation of life prolonging form requires attention to detail, ensuring the proper declaration of your wishes regarding medical treatments. Start by understanding the purpose of the form, which allows you to cancel any previously declared instructions regarding life-sustaining treatment. Follow a methodical approach to completing and distributing the forms effectively.
What are life prolonging procedures?
Life prolonging procedures are medical interventions aimed at extending an individual's life, often in cases where they are unable to communicate their health decisions. This includes treatments like mechanical ventilation, CPR, and artificial nutrition. Understanding these procedures is crucial when considering advance directives, which legally outline your medical care preferences.
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Medical measures taken to sustain life in patients facing critical health conditions.
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Advance directives ensure that your healthcare wishes are respected when you cannot speak for yourself.
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Various laws govern advance directives, including state-specific regulations that guide how they should be implemented.
How can you revoke your life prolonging procedures declaration?
The revocation of life prolonging procedures declaration can take place through several methods—each designed to accommodate different needs and situations. It's important to understand these methods for effectively communicating your decision.
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Formally state your intent to revoke the declaration in a signed document.
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Physically destroy the original document, which also serves as a valid form of revocation.
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Clearly communicating to your healthcare provider verbally can also denote your wish to revoke.
Whichever method you choose, ensure you follow up with appropriate parties, including your healthcare provider, to confirm they are aware of your revocation.
How should you fill out the revocation form?
Filling out the revocation form accurately is essential to ensure your wishes are clearly communicated. Each section has specific information that needs to be provided.
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Your signature indicates a formal, personal acknowledgment of the revocation.
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Print your name clearly and date the document to validate your revocation.
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Provide your current address so that the healthcare providers can easily contact you if needed.
Utilizing tools available on pdfFiller can make the process of editing and signing the document easy and efficient, supporting your goal of creating compliant and clear revocation documentation.
What legal considerations do you need to be aware of?
Legal considerations are fundamental when revoking a life prolonging procedures declaration. Familiarizing yourself with legislation and compliance notes relevant to your state can help you navigate this process more effectively.
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Understanding local laws governing advance directives and revocation ensures your actions align with legal expectations.
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You have the right to change your medical treatment preferences as per your current wishes and health condition.
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Different states may have unique regulations. Always check any region-specific stipulations before proceeding.
How should you share your revocation notice?
Distributing your revocation notice is a vital step in the process to ensure that all relevant parties are aware of your current healthcare wishes. Best practices include informing your healthcare providers, family, and any healthcare agents.
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Communicate promptly with everyone involved in your care to ensure they are clearly aware of your revocation.
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Make sure to discuss the potential consequences and legal obligations involved in your system of sharing.
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Leverage pdfFiller’s tools to securely send and store your documents to avoid miscommunication and preserve confidentiality.
How to fill out the revocation of life prolonging
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1.Begin by accessing the revocation of life prolonging form on pdfFiller.
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2.Ensure you have information regarding your previous consent and any relevant medical history.
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3.In the form, clearly state your full name, date of birth, and contact information in the designated fields.
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4.Next, specify that you wish to revoke any prior directives regarding life-prolonging treatments.
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5.Include the date of the original consent you are revoking, if available.
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6.Optionally, you may provide a brief explanation for this decision.
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7.Review the document for accuracy, ensuring all information is correctly filled out.
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8.Once completed, sign and date the document where indicated.
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9.Finally, save the document, and consider printing copies for your medical provider and family.
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