Indiana Health Care Representative Agreement | Medical POA | Healthcare Proxy: Free Blank Printable Template Downloads

A Indiana Health Care Representative Agreement is a document that allows a person to pick a healthcare agent that can make decisions on their behalf. It is useful for the elderly and those in high-risk situations. Once completed, the form should be kept by multiple family members and the designated agent for easy access during an emergency.

Last updated July 24th, 2024

A Indiana Health Care Representative Agreement is a document that allows a person to pick a healthcare agent that can make decisions on their behalf. It is useful for the elderly and those in high-risk situations. Once completed, the form should be kept by multiple family members and the designated agent for easy access during an emergency.

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An Indiana Health Care Representative Agreement (Healthcare Proxy) is a legal document used to appoint an agent to make medical care decisions on behalf of an individual if they are unconscious, incapacitated, or mentally incompetent.

Standard Durable Power of Attorney Forms

heaathcare-advance-directive-medical-power-of-attorney-form

Law Alert ⚖️

Indiana State Laws – Health Care Advance Directives, Article 36, Chapter 7

Legal Definition of “Power of Attorney” in Indiana

“”Power of attorney” means a writing or other record that grants authority to an attorney in fact or agent to act in place of a principal, whether the term “power of attorney” is used. The term refers to all types of powers of attorney, including durable powers of attorney, except for the following:

(1) A power to the extent it is coupled with an interest in the subject of the power, including a power given to or for the benefit of a credit in connection with a credit transaction.
(2) A proxy or other delegation to exercise voting rights or management rights with respect to an entity.
(3) A power created on a form prescribed by a government or governmental subdivision, agency, or instrumentality for a governmental purpose.”

Source: § 30-5-2-7

Legal Definition of “Health Care” in Indiana

“”Health care” means any medical care, treatment, service, or procedure to maintain, diagnose, treat, or provide for the principal’s physical or mental well-being. The term includes the providing of nutrition and hydration through intravenous, endotracheal, or nasogastric tubes.”

Source: Ind. Code § 30-5-2-4

Indiana Health Care Representative Agreement Template: Preview Sample

Example

INDIANA ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM

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