Free Indiana Living Will Form

The Indiana Living Will Declaration, also known as “Form 55316”, is an official document that is a part of the Indiana Advance Directive. It protects the rights of a resident who wishes to state their preferences concerning end-of-life care in case of becoming incapable of expressing them.

The living will form is of immense importance for those who suffer from incurable illnesses and older adults. However, it is worth looking into for any person concerned about how to manage his future health care in an unpredictable situation, for example if the ability to speak for yourself is lost under any circumstances such as a stroke or accident.

indiana living will form

Create a free high quality Indiana Living Will online now!

Build Your Document

Answer a few simple questions to make your document in minutes

Save and Print

Save progress and finish on any device, download and print anytime

Sign and Use

Your valid, lawyer-approved document is ready

... or download your Indiana Living Will Form as a  PDF file or   Word file
Create a free high quality Indiana Living Will online now!

Signing Requirements and Laws

It is declared in § 16-36-4-10 of Indiana state law that an individual who has reached the age of 18 may want to give written instructions about the withholding or withdrawal of the medical procedures that prolong his life. It is against the law for the attending physician to decide which treatment to perform if the patient loses the ability to communicate.

The following terms concerning Living Wills and Life Prolonging Procedures can be found defined in Title 16-36-4 of Indiana state law:

  • Life prolonging procedure: the ways, which are humane and not against the law, aimed to elongate the patient’s life medically.
  • Terminal condition: a condition caused by an injury, illness, or disease that left a patient comatose, physically or mentally dysfunctional, and, according to the observation of a doctor, cannot be cured. Such a condition will lead to death within a short period.
  • Life-prolonging procedures declarant: the one who has opted for life-prolonging procedures in writing, dated, and signed. If a person wishes to extend his life with medical treatment, he chooses this as an opposite to Indiana Living Will Declaration, which is usually meant to be a document where you instruct the doctors not to sustain your life in a life-threatening situation.
  • The living will declarant: the resident who executed a living will declaration in writing, dated and signed, and in the presence of two witnesses (this will be mentioned later).
  • Qualified patient: this is someone officially certified as qualified by an attending physician.

The Living Will Form will not be evaluated as valid unless two competent witnesses sign the document stating they have no doubts that the declarant is aware of the choice they are making. According to Indiana state law, a witness should not be the declarant’s spouse, child, or parent and should be at least 18 years of age. It has to be someone known by the person stating their living will.

You may want to pay your attention to the fact that if a person does not want to make decisions about his future medical treatment when he is comatose or unable to verbally express the instructions he would like the medical personnel to follow, there is an option of establishing an agent, who will be responsible for life prolongation or natural death of the declarant if the latter fills in the Health Care Representative Appointment, or “Form 56184.”

Ensure that your relatives or attorney know that the Living Will Declaration has been created and inform them of the location. In case of an accident, there will be an opportunity to register and follow the form’s directions.

Indiana Living Will Form Details

Document Name Indiana Living Will Form
State Form Name Indiana Living Will Declaration, Indiana Form 55316
Signing Requirements Two Witnesses
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: Indiana Code, Sections 16-36-4-0.1 to 16-36-4-21

Template Preview
Create a free high quality Indiana Living Will online now!

Steps to Fill Out the form

Once a person decides to complete and sign the Living Will Form, they will need to follow five simple steps below:

1. Download the form

The Indiana Living Will Declaration is available on our website as a PDF file. You can conveniently use our Online Forms Building Software to fill out the Indiana Living Will form.

2. Input your personal info

The first part of the declaration will need to be completed with your full name and month and year of establishing your decisions.
Personal information indication of living will for Indiana

3. Express your wish upon life-sustaining procedures

There are three possible options in this section of the document, which are: receiving artificial hydration and nutrition to sustain one’s life even if this turns out to be burdensome, turning down life-sustaining medical treatment, or making no decision and leaving this to a legal representative (Health Care Representative Appointment, or “Form 56184”).
Section for wish expressing upon life sustaining procedures of Indiana living will

4. Put your signature

To make this document effective, you will need to sign it, approving that your decisions have been made willfully.
Signature section of a document of living will for Indiana

5. Ensure Witnesses Signing the Declaration

After writing about the preferences you have chosen, leave the document for the people who agreed to witness that you have made your decisions without any force or in a state of mental dysfunction.
Witnesses signing section of a living will form for Indiana

seal of indiana state
Other Indiana Forms
Need other Indiana templates? We offer free forms and straightforward personalization experience to everyone who wishes for having fewer to none issues when facing paperwork.

Published: Jun 28, 2022
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.