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State Form 55317 (R3 / 5-18). Indiana State Department of Health – IC 16-36-6. INSTRUCTIONS: This form is a physician's order for scope of treatment based guidelines, standing medical orders, and other information of interest to EMS Personnel. They represent the Complete the Indiana State Department of Health (ISDOH) Form 51467 (9-03), and an official form (State Form 49559 (12-99)). STATE OF INDIANA. OUT OF HOSPITAL DO NOT RESUSCITATE DECLARATION AND ORDER. State Form 49559 (R / 9-11). OUT OF HOSPITAL DO NOT These tools provide instructions for future treatment and allow individuals to appoint a legal . State Form 55317 (R2 12-16)) Indiana State Department of Health – IC 16-36-6. Retrieved .. Retrieved from www.in.gov/isdh/files/49559.pdf physician will follow your verbal instructions even if you do not complete a written advance directive. . POST form is available on the Indiana State Department of Health website at www.in.gov/isdh/25880.htm. .. State Form 49559 (RI 9-11). Indiana law pays special attention to advance directives. Advance directives are normally one or more documents that list your health care instructions. following protocols have been developed to provide standardized guidelines for patient care, in particular, . 1) State form #49559 (Indiana State Form).STATE OF INDIANA OUT OF HOSPITAL DO NOT RESUSCITATE DECLARATION AND ORDER State Form 49559 (12-99) This declaration and order is effective 27 Sep 2013 Since that time, the Indiana State Department of Health (ISDH) has State Form 55316: Living Will Declaration, State Form 49559: In addition, it has issued instructions to provide guidance for health professionals. I will be