Indiana Living Will Form

The Indiana living will is a legal document that provides the ability for an individual to document in advance and while they are of sound mind, their personal wishes pertaining to how they would like their medical providers to implement their care in and end of life scenario. Since this document does not allow a Principal to appoint a health care representative, the Principal should speak with their family with regard to their choices in this event. This document will require the signatures of two unrelated (in any way) witnesses in order to be legally effective. The document shall become effective as of the date that is entered unless it is revoked or until the death of the Principal

Laws – §16-36-4-1 et seq. Living Wills and Life Prolonging Procedures Act

How to Write

Step 1 – Download the document and enter the date of execution of the document

  • The Principal must read the next two paragraphs
  • The Principal must then select from one of the three scenarios and apply their initials in the line preceding the applicable statement
  • The Principal should discuss the contents of this document with family members to ensure that they will honor the Principal’s decisions contained in the document
  • Submit the Principal’s Signature
  • AND
  • City, County and state of residence

Step 2 – Witness Signatures – The witnesses must not be related in any way, to the Principal:

  • Each witness must carefully review and agree to the witness statement
  • The witnesses must enter their respective information as follows:
  • Witnesses Signatures
  • Date the signatures in mm/dd/yyyy format