Document.com
State of Indiana

Free Indiana Medical Power of Attorney Forms

Create a Indiana-compliant healthcare power of attorney to appoint a trusted healthcare representative. Includes HIPAA authorization, end-of-life preferences, and all provisions required under Ind. Code § 16-36-1-7.

4.8 rating
|
13,267 IN documents created
|
Takes 5-10 minutes

Free to create and preview. Download as PDF or Word.

Indiana Healthcare Power of Attorney
PDFWord
Indiana-compliant
Page 1 of 5
SG

Written by

Stefan Gol
AH

Fact-checked by

Anderson Hill
JD

Legally reviewed by

John Doe

Last updated March 10, 2026

Indiana Healthcare Power of Attorney Overview

In Indiana, a healthcare power of attorney is governed by Ind. Code § 16-36-1-7. This legal document allows you to designate a healthcare representative who can make medical decisions on your behalf if you become unable to make or communicate those decisions yourself. Indiana law ensures that your healthcare representative has the authority to work with healthcare providers to carry out your wishes regarding medical treatment.

Your healthcare representative can make decisions about medical treatments, surgeries, medications, hospital stays, end-of-life care, and access to your medical records. The healthcare power of attorney typically takes effect only when a physician determines that you are unable to make decisions for yourself, though Indiana law may allow you to make it effective immediately if you prefer.

Creating a healthcare power of attorney in Indiana requires 2 witnesses and notarization is strongly recommended. While Indiana does not mandate a specific form, the document must meet all requirements under Ind. Code § 16-36-1-7.

No

Statutory form required

2

Witnesses required

Recommended

Notarization

Recommended

HIPAA included

Indiana Requirements

To create a valid healthcare power of attorney in Indiana, you must meet the following requirements under Ind. Code § 16-36-1-7:

Important: Indiana Execution Requirements

Indiana requires 2 witnesses for a valid healthcare power of attorney. Notarization is strongly recommended for added legal protection. Witnesses cannot include your designated healthcare representative or your treating healthcare provider.

  • Legal Age: You must be at least 18 years old and mentally competent at the time of signing
  • Witnesses: Indiana requires 2 witnesses who are not the healthcare representative or healthcare provider
  • Notarization: Recommended in Indiana
  • Agent Designation: Name a primary healthcare representative and optionally an alternate
  • HIPAA Authorization: Recommended to include separately

How to Create Your Indiana Healthcare Power of Attorney

Follow these steps to create a valid healthcare power of attorney that complies with Indiana law.

1

Choose Your Healthcare Representative

Select a trusted individual to serve as your healthcare representative in Indiana. This person should understand your healthcare values, be willing to advocate on your behalf, and be available in case of emergency. Consider naming an alternate healthcare representative as well.

2

Specify Your Healthcare Wishes

Document your preferences regarding medical treatments, end-of-life care, organ donation, DNR orders, and mental health treatment. Be as specific as possible about what treatments you do and do not want under various circumstances.

3

Include HIPAA Authorization

Add HIPAA authorization to ensure your healthcare representative can access your medical records and communicate with your healthcare providers in Indiana. Without this, providers may legally refuse to share your medical information.

4

Sign with Witnesses

Execute the document with 2 witnesses as required by Indiana law. Notarization is strongly recommended for added legal protection. Distribute copies to your healthcare representative, physicians, hospital, and family members.

Choosing Your Indiana Healthcare Representative

In Indiana, your healthcare representative will have significant authority over your medical care. Choose someone who understands your values and can make difficult decisions under pressure.

  • Trustworthy: Someone who will follow your wishes, not impose their own preferences
  • Accessible: Someone who can be reached quickly and can travel to Indiana if needed
  • Assertive: Someone who can communicate effectively with medical professionals
  • Emotionally capable: Someone who can handle the stress of making life-or-death decisions

Sample Indiana Healthcare Power of Attorney

Below is a preview of our Indiana-specific healthcare power of attorney template.

STATE OF INDIANA

HEALTHCARE POWER OF ATTORNEY

Ind. Code § 16-36-1-7

PRINCIPAL (You):

Name: [Your Name]
Address: [Indiana Address]

HEALTHCARE REPRESENTATIVE:

Name: [Agent Name]
Relationship: [Relationship]
Phone: [Phone]

Indiana Healthcare Power of Attorney FAQ

Answers to common questions about Indiana healthcare power of attorney requirements and procedures.

Official Indiana Resources

Use these official resources to verify Indiana requirements and access government forms.

Create Your Indiana Healthcare Power of Attorney

Answer a few questions and download your Indiana-compliant document in minutes.

No account required. Free to create and preview.