Patient resources and forms

Recently, Indiana passed a law that changed how Indiana residents complete advance directive documents.

The new law does not mandate the use of a specific form. Indiana residents now have greater flexibility in determining the forms they want to use, including “Five Wishes” and “Prepare for Your Care.” The Indiana Patient Preferences Coalition, a statewide group which promotes high-quality advance care planning, created a standardized Indiana advance directive document that can be found here:

• English
• Spanish (for reference only)
• Burmese (for reference only)

This advance directive (AD) is a legal document you can use to:

• Appoint a health care representative (HCR) to speak on your behalf in the event that you cannot make treatment decisions because of your health condition.
• Identify treatment preferences for future care.

In completing this advance directive, you should carefully consider who to name as your HCR, including considering who your backup representative could be.

You should also reflect on what matters most to you so that your AD aligns with your values and beliefs. For assistance with this form and education about sharing health care wishes with the people who matter most, please email acpdept@parkview.com or use MyChart to schedule a free advance care planning conversation.

Advance directive documents that you have already completed can be emailed to acpdept@parkview.com or uploaded through MyChart to be entered into your electronic medical record.

Taking the above steps is very important. We cannot honor your wishes unless we know what they are, have a conversation about them and have copies of the documents.

Please note that prior to this change there were three forms that were recognized by Indiana law and maintained by the Indiana State Department of Health:

• Appointment of a Health Care Representative.
• The Living Will.
• The Life-Prolonging Procedures Declaration.

Those forms are no longer available. However, if you completed one of these forms prior to December 31, 2022, it remains valid, and you do not have to complete a new document unless you choose to do so.

When your child is injured or becomes ill and you can’t be there, we’ll provide the necessary medical attention. This form enables healthcare professionals to treat your child for minor emergencies when, and only when, you cannot be notified.

By filling out the form, you'll be able to provide not only your permission for medical treatment, but also important health information needed for the care of your child. You may want to keep one copy for yourself and give another copy to the person who will be responsible for your child when you cannot be present. Be sure to specify that person’s name on the form.

Consent Form