Get In 49559 2011-2025

Filling out the IN 49559 form, which is the Out of Hospital Do Not Resuscitate Declaration and Order, is a crucial task for individuals wishing to outline their healthcare preferences. This guide provides clear instructions to help users complete the form accurately and effectively.

Follow the steps to successfully complete the IN 49559 form online

1. Click the ‘Get Form’ button to access the IN 49559 form and open it in your preferred editing tool.
2. Begin by filling out the declaration section. Enter the current date, your full name, and confirm that you are at least eighteen years old and of sound mind.
3. Indicate in the form that your attending physician has certified you as a qualified person, meaning you have a terminal condition or a medical condition that would result in unsuccessful resuscitation.
4. Specify your directives regarding cardiopulmonary resuscitation (CPR) procedures. Clearly state that in case of cardiac or pulmonary failure outside of an acute care hospital, you do not wish for resuscitation procedures to be performed.
5. Understand and acknowledge your right to revoke this declaration at any time by signing and dating a new document, destroying the current one, or communicating your wish to healthcare providers.
6. Proceed to sign and print your name, and provide your city and state of residence in the designated sections.
7. Two witnesses must sign the document confirming that they know you and believe you are of sound mind. They must also print their names and provide the date of signing.
8. Finally, the attending physician needs to fill out their section. The physician must sign, print their name, include their medical license number, and the date of certification.
9. Once all sections are completed, ensure that the form is saved, and consider downloading, printing, or sharing it as needed.

Take action by completing your IN 49559 form online to ensure your healthcare wishes are known.