Free Indiana Living Will Form

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An Indiana living will is a written declaration that tells doctors whether to use life-prolonging procedures if a person becomes terminally ill and unable to communicate. It is part of the state's advance directive process. Under Indiana law, an adult of sound mind may sign one to direct that such procedures be withheld or withdrawn.[1.1]

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A living will form is useful for anyone managing a serious illness, not only older adults. A sudden event such as a stroke or an accident can take away the ability to communicate at any age. Having the declaration in place lets your own wishes guide your care instead of leaving the decision to someone else.

Signing Requirements and Laws

Under Ind. Code § 16-36-4-8, a person may make a living will declaration if they are of sound mind and at least eighteen (18) years of age. The declaration must be in writing, dated, and signed by the declarant, or by another person in the declarant's presence and at the declarant's express direction. It must also be made voluntarily.[1.1]

The declaration uses a few terms worth knowing before you fill it out:

  • Life-prolonging procedure: medical treatment intended to extend a patient's life.
  • Terminal condition: an incurable injury, illness, or disease that a physician expects will cause death within a short time.
  • Life-prolonging procedures declarant: a person who has signed, dated, and witnessed a written choice to receive life-prolonging procedures rather than have them withheld.
  • Living will declarant: a person who has signed, dated, and witnessed a living will declaration directing that life-prolonging procedures be withheld or withdrawn.
  • Qualified patient: a patient whose attending physician has certified their condition under the declaration.

The declaration must be signed in the presence of at least two competent witnesses who are at least eighteen (18) years of age, or acknowledged before a notary public. A witness may not be any of the following:[1.1]

  • A parent, spouse, or child of the declarant.
  • A person entitled to any part of the declarant's estate, whether the declarant dies with or without a will.
  • A person directly financially responsible for the declarant's medical care.
  • The person who signed the declaration on the declarant's behalf and at the declarant's direction.

"The declarant has been personally known to me, and I believe (him/her) to be of sound mind. I did not sign the declarant's signature above for or at the direction of the declarant. I am not a parent, spouse, or child of the declarant. I am not entitled to any part of the declarant's estate or directly financially responsible for the declarant's medical care. I am competent and at least eighteen (18) years of age."

Statement each witness signs under the declaration, Ind. Code § 16-36-4-10 [1.2]

The declarant must notify their attending physician that the declaration exists. Once notified, the physician must make the declaration, or a copy of it, part of the declarant's medical records. If the attending physician has diagnosed the declarant as pregnant, the declaration has no effect during the pregnancy.[1.1]

Tip: Tell a family member, your doctor, or your attorney where you keep your signed living will so it can be found and followed when it is needed.

Indiana Living Will Form Details

Document Name Indiana Living Will Form
State Form Name Indiana Living Will Declaration
Signing Requirements Two Witnesses or a Notary Public
Validity Requirements Section 16-36-4-8
Specific Powers Section 16-36-4-10
Avg. Time to Fill Out 13 minutes
# of Fillable Fields 48
Available Formats Adobe PDF; Microsoft Word
State Laws: Ind. Code §§ 16-36-4-8, 16-36-4-10

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Create a free high quality Indiana Living Will online now!

Steps to Fill Out the Form

The screenshots under each step show the FormsPal Indiana living will template filled with sample entries in blue, so you can see where each answer goes. The names, addresses, dates and amounts are examples only.

The Indiana living will and medical power of attorney packet runs eight pages with 48 fillable fields. It covers your health care wishes and, if you choose to include it, an agent to make health care decisions for you. Follow the steps below in the order the form presents them.

  1. Complete the declaration header (page 2). Fill in the date, your full name, and your address at the top of the declaration.
    Indiana living will: living will declaration, filled with sample entries
    Step 1: sample entries, not a real living will.
  2. Initial the treatment and end-of-life statements (page 2). Initial each line for the specific treatments you refuse and the end-of-life conditions that reflect your wishes.
    Indiana living will: health care and end of life choices, filled with sample entries
    Step 2: sample entries, not a real living will.
  3. Add additional instructions (page 3). Use the blank lines to add any further instructions, or leave this section blank if you have none.
    Indiana living will: additional instructions, filled with sample entries
    Step 3: sample entries, not a real living will.
  4. Appoint your health care agent (page 3). Enter the name, address, and phone number of the person you appoint as your agent under the medical power of attorney.
    Indiana living will: health care agent, filled with sample entries
    Step 4: sample entries, not a real living will.
  5. Name a substitute agent (page 4). Enter the name, address, and phone number of a backup agent who can act if your first agent is unable to.
    Indiana living will: substitute agent, filled with sample entries
    Step 5: sample entries, not a real living will.
  6. Review the powers granted to your agent (pages 4 to 6). Read through items A through J describing what your agent is authorized to do on your behalf.
    Indiana living will: agent powers
    Step 6: the part of the living will this step covers.
  7. Review when the power of attorney takes effect (page 6). Read the paragraphs on when the power becomes effective and the HIPAA medical information release.
    Indiana living will: when the medical power of attorney takes effect
    Step 7: the part of the living will this step covers.
  8. Review the remaining provisions (page 7). Read the agent's duty standard, ratification, conservator nomination, photocopy authorization, revocation of prior powers, and severability clauses.
    Indiana living will: remaining provisions
    Step 8: the part of the living will this step covers.
  9. Sign and date the declaration (page 8). Sign, print your name, and enter the date in the signature block.
    Indiana living will: sign and date, filled with sample entries
    Step 9: sample entries, not a real living will.
  10. Complete the witness signatures (page 8). Have two witnesses each print their name, address, and city and state, then sign and date under the witness acknowledgment.
    Indiana living will: witness acknowledgment, filled with sample entries
    Step 10: sample entries, not a real living will.
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Frequently Asked Questions

How to Do a Living Will in Indiana?

To make a valid Indiana living will, sign and date the declaration while of sound mind and at least eighteen (18) years old, made voluntarily and in writing. Sign it in the presence of at least two competent witnesses at least eighteen (18) years old, or before a notary public. Notify your attending physician once the declaration is complete.[1.1]

The witnesses cannot be your spouse, parent, or child, or a person who stands to inherit from you.[1.1]

Does a Living Will Need to Be Notarized in Indiana?

No. Indiana does not require a living will to be notarized. Some people also ask whether a living will has to be notarized in Indiana, and the answer is the same either way. The declaration is valid if it is signed in the presence of at least two competent witnesses, or, as an alternative to witnesses, acknowledged before a notary public.[1.1]

General information, not legal or tax advice.

Sources

  1. Ind. Code §§ 16-36-4-8 to 16-36-4-10.
    • 1.1 § 16-36-4-8
    • 1.2 § 16-36-4-10

Mara Erlach
Mara Erlach
Writer & Attorney
Mara has been practicing estate planning and trust law in California since 2003, taking pride in helping clients of all backgrounds and asset profiles form a complete and customized estate plan. Her specialties are: estate planning, wills and trusts, trust and probate administration.