Indiana Medical Power of Attorney (POA) Form

In Indiana, residents can create a Medical Power of Attorney certificate, which correlates with the 56184 Form and sounds like Indiana Power of Attorney for Health Care Decisions and Appointment of Health Care Representative.

It is always a good idea to provide security for the future, and the medical power of attorney form creates additional layers of safety and assurance that everything will be executed the way you prefer. A Health Care Power of Attorney certificate allows an individual to select a dependable person who will execute the principal’s wishes regarding health care therapy and medical preferences if the declarant becomes incapacitated, unconscious, and unable to express his or her decisions directly.

Indiana power of attorney forms – this category will help you learn more about other powers of attorney you can use in Indiana.

indiana medical poa

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Indiana Power of Attorney for Health Care Decisions and Appointment of Health Care Representative paper allows the designated attorney-in-fact control and render arrangements on the following matters:

  • Choose and contract with medical care providers.
  • Consent to or decline medical therapies that aim to support, treat, or cancel the principal’s physical and mental conditions
  • Have sufficient access to the therapeutic histories and records
  • Consent to or refuse an autopsy
  • Execute anatomical donation on the declarant’s behalf
  • Arrange funeral and body disposition

In most cases, a Medical POA is the point where uncertainties regarding one’s health care wishes vanish. Thus it is a good idea to have such a certificate completed before some serious life-threatening medical therapy or surgery performed under anesthesia.

In the following section of our review, we will cover the inherent requirements and laws that one must obey while completing the form.

Laws and Requirements

Under 16-36-1 of the Indiana Code, the creation of the Indiana Power of Attorney for Health Care Decisions and Appointment of Health Care Representative certificate doesn’t require much effort. However, there are several conditions that one must follow to delegate the responsibilities and powers correctly and maintain the paper valid.

To be able to delegate the powers to the health care representative, you must perform the listed below requirements:

  • You must provide the Indiana Medical POA document in writing — unless you submit the instructions through written communication, the certificate doesn’t provide any legal authorities.
  • The Indiana Medical POA requires a mandatory principal’s signature. Thus the form is to be acknowledged while the declarant is still capable of signing it on his or her own behalf.
  • The certificate requires authorization by one adult witness other than the appointed health care attorney.
  • Granted powers become effective only after the declarant becomes incapable, unconscious, or incapacitated and cannot communicate the wishes and render decisions on his or her own. However, if the declarant regains the ability to make choices, the paper is not effective. Thus the declarant can revoke the paper in writing or orally.
  • The designated attorney-in-action must be an individual of 18 or older or any legal entity.
  • The selected attorney obtains the same rights as the principal and can access any medical records.
  • 16-36-1 of the Indiana Code does not authorize euthanasia.

Indiana Medical Power of Attorney Form Details

Document Name Indiana Medical Power of Attorney Form
State Form Name Indiana Health Care Representative Appointment
State Laws Indiana Code, Title 16, Article 36
Signing Requirements One Witness
Who Can’t Be the Agent? Section 16-36-1-9.5
Who Can’t Be the Witness? Section 16-36-1-7
Avg. Time to Fill Out 8 minutes
# of Fillable Fields 21
Available Formats Adobe PDF

Popular Local Medical POA Forms

Health care POA forms let you establish a proxy who can manage your health matters in case you get unable to make decisions yourself. Below are the states MPOA documents are downloaded in most often.

Filling Out the Form

We dedicate this section to the inherent steps that one should follow while creating the Indiana Power of Attorney for Health Care Decisions and Appointment of Health Care Representative (Medical POA) certificate.

  • Download the Template

You are encouraged to use our form building software to create an Indiana Medical POA certificate. To reduce ambiguity, we provide a comprehensive checklist of what to insert next.

  • Define the Principal and the Health Care Agent

Submit the legal names of the principal and the selected attorney-in-fact. Specify the address and residency for both persons. It is an excellent idea to contribute as much contact data as possible because your agent may be called out unexpectedly. Therefore, please insert the representative’s mobile, home, and work phone numbers.
Principal and health care agent indication section of Indiana medical power of attorney form

  • Assign Powers to the Attorney-In-Fact

Specify which powers you delegate to your health care agent by placing your initials next to every chosen alternative.
Powers assignment part of medical power of attorney template for Indiana

  • Define the alternate Representative

In case your attorney of choice refuses to follow the directions described in the paper or any other unforeseen circumstances may occur, make sure you select a back-up representative. Write down the successor’s legal name, full address, and phone numbers.
Altenate representative defining section of Indiana mpoa document

  • Collect the Declarant’s Signature

Once you have submitted identities and listed instructions, it is time to sign the document. Insert the date in day, month, year format, place your signature, and printed name.
Part for declarant's signature of a document of mpoa for Indiana

  • Submit the Witness’s Data

In the state of Indiana, a signature of one adult witness will be sufficient to authorize the Power of Attorney for Health Care Decisions and Appointment of Health Care Representative (Medical POA) certificate. The witness must be different from the health representative person and must be present when the principal places their signature. Submit the witness’s printed name, signature, and date.

You don’t need to notarize the document.
Witness data submitting section of Indiana medical power of attorney template

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Other Indiana Forms

We provide a range of key Indiana templates to anybody striving for convenience when dealing with various agreements, contracts, and other paperwork.

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Published: Nov 19, 2020