Indiana Medical Power of Attorney Form [PDF]

Secure your healthcare preferences if you become unable to make your healthcare decisions by drafting the Indiana Medical Power of Attorney.

Last update: 27 Mar 2024

Indiana Medical Power of Attorney Form [PDF]

The Indiana medical power of attorney, or healthcare power of attorney, is a legal document that one person, called the principal, uses to authorize another person, called the agent or the attorney-in-fact, to make healthcare decisions on their behalf in case they become unable to do so.

The medical power of attorney form includes a list of treatments and medications that the principal wants or doesn’t want to be subjected to in case they become unable to make such decisions themselves. 

The document can also include their end-to-life preferences or their preferences about artificial nutrition or hydration.

Laws and Legal Requirements for a Medical Power of Attorney in Indiana

Laws and Legal Requirements

Title 16, Article 36 of the Indiana Code regulates the status of the Indiana medical power of attorney.

The principal must sign the document before at least one adult witness for the document to be valid and effective, as provided by §16-36-1-7. State law doesn’t provide the notarization requirement. However, this step is always recommended.

The medical power of attorney is valid indefinitely or until the principal revokes it. The principal can also set the document termination date at the moment of issuing it. The principal can revoke the document both orally and in written form. However, written forms always provide more security for all parties involved.

How to Write a Medical Power of Attorney in Indiana

In Indiana, the easiest way to issue a medical power of attorney is by following the steps below:

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

On our website, you will find the medical power of attorney template. All you have to do is access the document, and our advanced document builder will provide you with step-by-step instructions on how to fill out the template.

First, you should enter the basic details, such as the principal’s full name, mailing address, contact details, and the date of issuing the power of attorney.

#2. Appoint a Healthcare Representative

This should be a person that you want to authorize to represent you and make decisions about your healthcare on your behalf. This should be an adult with the legal capacity to represent you. You should choose someone you can trust and who is physically available to act on your behalf.

In this section, you should enter:

  • Agent’s full name

  • Agent’s mailing address

  • Agent’s contact details

Here, you can also include the medical power of attorney rights and limitations and define the scope of your agent's authority.

#3. Identify an Alternative Healthcare Representative

The alternative healthcare representative is also called the secondary agent or the secondary attorney-in-fact. They will act on your behalf only if the primary agent loses their legal capacity, passes away, or is, in other ways, unable to represent you.

The secondary agent should meet the same basic requirements as the primary agent. They should be of legal age, have the legal capacity, and be trustworthy. 

You can appoint more than one person as your secondary agent. They will also have the same scope of authority as your primary agent.

#4. Identify the Witnesses and Have Them Sign the Form

After completing the medical power of attorney form, you should print and sign it. You should sign the document before at least one witness. The witness must be an adult with legal capacity. 

Failing to provide the witness signature on your medical power of attorney will undermine its validity and effectiveness.

#5. Notarize the Form

Although this step is not required by Indiana state law, it is always recommended to have the notary public acknowledge your document

The notary public will confirm the identity of all the parties signing the document and confirm that they have personally signed it. This will prevent potential fraud and confirm the authenticity of the document.

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