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Free Indiana Medical Power of Attorney Form

An Indiana medical power of attorney names a health care representative inside the state's advance directive. Fill out our guided form and choose the signing route that works for you.

  • Download as PDF and Word
  • E-sign included

How It Works

1

Select Your Template

Choose the state or form type you need to start.

2

Fill In Your Details

Answer a few simple questions to customize your form.

3

Get Your Form

Download or print your custom document in PDF or Word.

What Is a Medical Power of Attorney in Indiana?

Since July 1, 2021, Indiana uses one advance directive to appoint a health care representative and record your treatment wishes. That representative becomes your Indiana medical power of attorney agent once a doctor finds you cannot make and share your own decisions.

Indiana Signing Rules at a Glance

Senate Enrolled Act 204 created Indiana Code chapter 16-36-7, which now governs these documents.

Two Adult Witnesses or a Notary

The state form says the directive must be signed by two adult witnesses or notarized to be legally valid. You only need one of those routes.

One Witness Must Be Outside the Family

If you use witnesses, at least one of them cannot be your spouse or another relative. Each witness confirms they had satisfactory proof of your identity and that you appeared of sound mind.

Someone Can Sign for You

If you are physically unable to sign, another adult can sign in your name at your direction. The Indiana Disability Rights form includes a line for that person’s printed name.

Signing Replaces Older Forms

The state-agency form includes a statement that signing it revokes any earlier health care power of attorney or health care representative form. Before you sign, decide whether that is what you want.

Can Witnesses Sign by Phone in Indiana?

Yes, Indiana’s form includes a telephone option. You initial a box stating that you signed after talking with and listening to your two witnesses by telephone only.

That flexibility helps if you are in the hospital or your witnesses live far away. The witnesses still confirm your identity and your capacity, so choose people who can do that honestly over the phone.

Name a Backup Representative

Indiana’s agency form has space for a backup representative who steps in if your first choice cannot act. Filling it in avoids a gap if your primary representative is traveling, ill, or unreachable.

How to Sign Your Indiana Medical Power of Attorney

Walk through these steps to finish your Indiana medical power of attorney form:

  1. Write your legal name and your representative’s name and phone number.
  2. Add a backup representative, if you have one.
  3. Record any values or treatment wishes your representative should follow.
  4. Pick your route: two adult witnesses, including one non-relative, or a notary.
  5. Sign in person, or initial the telephone box if witnesses join by phone.
  6. Give copies to your representative, your backup, and your doctors.

What to Include in Your Indiana Form

Your representative must follow your wishes and values, including your ideas about dignity and quality of life. When those wishes are unknown, they act in good faith and in your best interest. The Indiana Disability Rights form lists these decisions:

  • Agreeing to medical treatment
  • Refusing medical treatment
  • Stopping medical treatment
  • Arranging comfort care

A clear Indiana medical power of attorney spells out your values in your own words, so your representative is not left guessing.