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Advance Directives

Your Right To Decide

What is an Advance Directive?

An Advance Directive is a document or verbal statement in which an adult person (18 years or older) states choices for accepting or refusing medical treatment, or names someone who should make treatment choices if the person loses decision making capacity.

What is the purpose of Advance Directives?

IU Health recognizes that all competent adults have the right to accept or refuse any medical treatment. Many people have strong feelings about the kind of medical care they would like to receive or refuse in certain circumstances. Advance Directives allow us, while we are of sound mind, to state our feelings clearly so that our care preferences can be honored even if we cannot speak for ourselves.

Are Advance Directives required?

No person is required to have an Advance Directive in order to receive health care services at IU Health. No conditions are placed on care provided based on whether or not an Advance Directive has been done.

Why does IU Health ask patients about Advance Directives?

Protecting your right to express choice through Advance Directives upholds the IU Health value Respect which “supports the rights of the patient to participate in all decisions that affect their health care”. Federal law (the Patient Self-Determination Act of 1990), the Center for Medicare and Medicaid Services, and Joint Commission standards require that every health care institution ask patients if they have an Advance Directive and provide Advance Directive information to patients who request it.

Why is an Advance Directive important to patient care?

In certain circumstances the Advance Directive guides care if you are unable to speak for yourself. The Advance Directive titled “Appointment of a Health Care Representative” also identifies the person you have chosen to serve as substitute decision maker if you cannot speak for yourself. If you have an Advance Directive, your doctors and care team need to know about it. You should provide a copy for your medical record.

What happens if the patient asks for more information about Advance Directives?

For additional information see the Advance Directives booklet provided by the Indiana State Department of Health. For persons admitted to an IU Health hospital, Advance Directive information is contained in the Patient Admission Packet. At the patient’s request, the nurse will contact trained personnel who meet with the patient to provide additional information about Advance Directives and can assist in completing the Advance Directive forms if requested.

Should I bring a copy of my Advance Directive(s) to the hospital?

Yes. When you are admitted to the hospital, it is important for you (or your family) to provide the hospital with a copy of any completed forms. 

These decisions are not easy to make. Discuss your choices with your doctors, family and friends. When you have completed one or more advance directive forms, give a copy to your doctor for placement in your medical record.

Indiana Law permits you to make advance directives using the following forms:

The information contained on this page is presented for your information only. Because these forms may have legal implications, the information should not be considered complete or used in place of a consultation with an attorney.

Appointment of a Health Care Representative

This form allows you to appoint another adult to make decisions about your health care, if you become unable to make your own choices. That person is expected to act according to your values. If you do not appoint a specific person to speak in your behalf, Indiana law says that your spouse, parents, adult siblings and adult children all have equal authority to make these decisions. (Note: someone with “power of attorney” does not have the authority to make health care decisions unless this is specifically written in the legal Power of Attorney document.)
Download a printable version (PDF)

Living Will Declaration 

If you become “terminally ill” and are expected to die within a short period of time, this completed form tells your doctor that you do not want certain procedures which would prolong the dying process.
Download a printable version (PDF)

Life-Prolonging Procedures Declaration

This form permits you to request the use of life-prolonging procedures that would maintain physical life and prolong the dying process, without regard to your condition or chances of recovery.  The Life-Prolonging Procedures Declaration is the opposite of the Living Will Declaration.
Download a printable version (PDF)

Organ/Tissue Donation

This form is used if you want to donate organs or tissues after your death. It can also be used to indicate your desire to donate your body for medical education and research after your death.
Download a printable version (PDF)

Physician Scope of Work (POST) Form

This form is a set of actionable orders for end of life patients across care settings.
Download a printable version (PDF)

Psychiatric Advance Directive

This form allows you, in consultation with your psychiatrist, to express mental health treatment preferences. This form is available only through your psychiatrist or other mental health counselor.

Out of Hospital Do Not Resuscitate Declaration and Order

This form allows you to say that you refuse CPR if your heart or lungs stop working when you are not in the hospital. Discuss with your doctor if you do not want to be resuscitated outside the hospital. This form must be filled out and signed by a physician.

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