Create Your Medical Power of Attorney

Official Medical Power of Attorney Form for Indiana

The Indiana Medical Power of Attorney form is a legal document that allows individuals to designate a trusted person to make healthcare decisions on their behalf if they become unable to do so. This form ensures that your medical preferences are honored, providing peace of mind for both you and your loved ones. To get started on filling out the form, click the button below.

Create Your Medical Power of Attorney

Overview

Documents used along the form

The Indiana Medical Power of Attorney form allows individuals to designate a trusted person to make medical decisions on their behalf in the event they become unable to do so. It is often used alongside several other important documents that can help ensure a person's healthcare wishes are honored. Below is a list of forms and documents that may be relevant.

Living Will: This document outlines a person's preferences regarding medical treatment in situations where they are terminally ill or incapacitated. It provides guidance on end-of-life care and the use of life-sustaining treatments.
Durable Power of Attorney: This legal document allows an individual to appoint someone to manage their financial affairs if they become incapacitated. It remains effective even if the person becomes unable to make decisions.
Do Not Resuscitate (DNR) Order: A DNR order specifies that a person does not want to receive CPR or other life-saving measures in case of cardiac arrest. It must be signed by a physician and is often kept in a visible location.
Non-disclosure Agreement Form: To protect sensitive information shared between parties, refer to the vital Non-disclosure Agreement template designed for safeguarding confidential information.
Health Care Proxy: Similar to a Medical Power of Attorney, a health care proxy designates someone to make medical decisions on behalf of another person. This document may be used when the individual is unable to communicate their wishes.
HIPAA Authorization: This form allows individuals to grant permission for healthcare providers to share their medical information with specific people. It ensures that designated individuals can access necessary health information.
Advance Directive: An advance directive combines a living will and a medical power of attorney. It provides instructions for healthcare decisions and designates a person to make those decisions if needed.
Patient Advocate Designation: This document allows an individual to appoint a patient advocate to help navigate the healthcare system and ensure that their medical preferences are respected.
Organ Donation Consent Form: This form indicates a person's wishes regarding organ donation after death. It can be included with other advance care planning documents to clarify one's intentions.

Each of these documents plays a critical role in ensuring that a person's healthcare preferences are respected and followed. It is advisable to consider these forms carefully and discuss them with trusted family members or legal advisors to create a comprehensive plan for medical decision-making.

Common mistakes

Not Specifying the Agent Clearly: One common mistake is failing to clearly identify the person designated as the agent. It's crucial to provide the full name and contact information of your chosen representative. Ambiguities can lead to confusion during critical moments.
Ignoring Alternate Agents: People often overlook the importance of appointing an alternate agent. If your primary agent is unavailable or unable to act, having a backup can ensure that your medical wishes are still honored.
Not Understanding the Powers Granted: Many individuals fill out the form without fully understanding what powers they are granting to their agent. It’s essential to read and comprehend the specific medical decisions your agent will be able to make on your behalf.
Failure to Sign and Date Properly: A frequent oversight occurs when individuals forget to sign and date the document. Without a signature and date, the form may not be considered valid, rendering your wishes unenforceable.

⇓ Medical Power of Attorney File

Key takeaways

When filling out and using the Indiana Medical Power of Attorney form, it is important to keep the following key takeaways in mind:

Eligibility: Ensure that the person you designate as your agent is at least 18 years old and capable of making medical decisions.
Specificity: Clearly outline your wishes regarding medical treatment and procedures. This helps guide your agent in making decisions that align with your values.
Signatures: The form must be signed by you in the presence of a notary public or two witnesses. This step is crucial for the document's validity.
Revocation: You have the right to revoke the Medical Power of Attorney at any time. Make sure to inform your agent and any healthcare providers of this change.
Distribution: Provide copies of the completed form to your agent, healthcare providers, and any family members involved in your care. This ensures that everyone is aware of your wishes.
Review Regularly: Periodically review and update your Medical Power of Attorney as your health or circumstances change. This keeps your directives current and relevant.

PDF Properties

Fact Name	Description
Definition	The Indiana Medical Power of Attorney form allows an individual to appoint someone else to make healthcare decisions on their behalf when they are unable to do so.
Governing Law	This form is governed by Indiana Code § 30-5-1-1 et seq., which outlines the legal framework for medical powers of attorney in the state.
Principal	The person creating the power of attorney is referred to as the "principal." This individual retains the right to make decisions until they are incapacitated.
Agent	The individual appointed to make medical decisions on behalf of the principal is known as the "agent." This person must be at least 18 years old.
Durability	The Indiana Medical Power of Attorney is durable, meaning it remains in effect even if the principal becomes incapacitated.
Revocation	The principal can revoke the power of attorney at any time, as long as they are still competent to make decisions.
Witness Requirement	The form must be signed in the presence of two witnesses or notarized to be valid. Witnesses cannot be related to the principal or the agent.
Scope of Authority	The agent has the authority to make a wide range of medical decisions, including choices about treatment options, surgeries, and end-of-life care.
Healthcare Providers	Healthcare providers are legally obligated to honor the decisions made by the agent, as long as the power of attorney is valid.
Form Accessibility	The Indiana Medical Power of Attorney form can be obtained from various sources, including healthcare providers, legal professionals, and online resources.

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Form Example

Indiana Medical Power of Attorney

This Medical Power of Attorney is created under the laws of the State of Indiana and serves to appoint an individual to make medical decisions on behalf of the undersigned. This document should be completed in full and stored in a safe place for future reference.

Principal's Information:

Name: ___________________________
Date of Birth: ___________________________

State: ___________________________

Zip Code: ___________________________

Agent's Information:

Name: ___________________________
Date of Birth: ___________________________
Address: ___________________________
City: ___________________________
State: ___________________________
Zip Code: ___________________________

Agent's Authority:

The Agent will have the power to make health care decisions on behalf of the Principal, including but not limited to:

Consenting to or refusing medical treatment.
Choosing health care providers or facilities.
Accessing and obtaining medical records.
Making end-of-life decisions, if necessary.

Effective Date: This Medical Power of Attorney shall become effective on the date it is executed.

Signature:

I, the undersigned, hereby nominate and appoint the above Agent to act on my behalf regarding medical decisions in accordance with Indiana law.

Principal's Signature: ___________________________

Date: ___________________________

Witness Signature:

Witness Name: ___________________________

Witness Signature: ___________________________

Date: ___________________________

Notary Public (if required):

State of Indiana, County of ___________________________

Subscribed and sworn before me this ______ day of ___________, 20__.

Notary Public Signature: ___________________________

My Commission Expires: ___________________________