Indiana § 12-10-21-6 - Standard medical information form
Full text of Indiana Indiana Code § 12-10-21-6 — Standard medical information form, with citation guidance and answers to common questions.
§ 12-10-21-6. Standard medical information form
Sec. 6. (a) The bureau shall create a standard medical information form that allows a program participant to supply the following information:
(1) The program participant's name.
(2) A photograph of the program participant.
(3) The contact information for not more than two (2) emergency contacts for the program participant.
(4) The program participant's medical information, including medical conditions, recent surgeries, allergies, and current medications.
(5) The program participant's hospital preference.
(6) The contact information for not more than two (2) health care providers of the program participant.
(7) The date the program participant completed the form.
(b) The standard medical information form must include the following statements:
(1) A statement that the program acts as a facilitator only, and that all information supplied on the medical information form is the sole responsibility of the program participant.
(2) A statement that the program participant supplies the medical information voluntarily, and that the program participant authorizes the disclosure and use of the medical information for the purposes described in section 9(b) of this chapter.
[Pre-2026 Revision Citation: 12-9.1-6-6.]
As added by P.L.122-2026, SEC.48.
Source: official Indiana text · Last verified 2026-08-27
Frequently Asked Questions About Indiana § 12-10-21-6
What does Indiana Code § 12-10-21-6 cover?
Section 12-10-21-6 ("Standard medical information form") is part of the Indiana Code, the codified statutory law of Indiana. It sets out the legal rule or procedure described in the text above. Statutes are amended regularly, so always verify against the official source.
How do I cite Indiana § 12-10-21-6?
A common citation format is "Indiana Code § 12-10-21-6" (Indiana). Legal writing may require the code abbreviation, section number, and year or edition. Match the style required by your court, professor, or publisher.
Is this the official text of Indiana law?
No. This page is for research and education and may not include the most recent amendments. For official current law, check the Indiana official source linked on this page or consult a licensed Indiana attorney.
How does Indiana § 12-10-21-6 apply to my situation?
Statutes are interpreted in context, and application depends on your specific facts. Only a licensed attorney in Indiana can advise on how this section applies to you. Contact your state or local bar association for a referral.
Sources & Verification
Not legal advice. Verify against the official source and consult a licensed attorney in Indiana.