Indiana Code Title 16. Health § 16-25-2-2

(1) the hospice's employees or a hospice patient or home health patient;  or

(2) family members of a patient;

(1) is signed and dated by a licensed physician;

(2) identifies the vaccine covered by the order;

(3) indicates that appropriate procedures are established for responding to any adverse reaction to the vaccine;  and

(4) directs that a specific medication or category of medication be administered if a recipient has an adverse reaction to the vaccine.