Fill form
Adobe PDF
Fill & Sign
The Ohio Advance Directive provides the dual function of allowing an individual to record their wishes pertaining to end-of-life medical treatment (living will) and also appointing a third party to act on their behalf in the event of their incapacitation (medical power of attorney). Along with these features, the document also contains a third section where the principal can stipulate their desires regarding organ/tissue donation in case death occurs. If this is of interest, the individual seeking to put forth the document should enter in all the required info, sign the instrument, and then have it either acknowledged by two (2) witnesses or a notary public.
This Document Contains:
Laws
Statute – Medical Power of Attorney (§ 1337.11 – § 1337.17), Living Will (§ 2133.02)
Definitions – A “durable power of attorney for health care” means a document created pursuant to § 1337.11 to § 1337.17 of the Revised Code (§ 2133.01(G)). A “declaration” means a written document executed in accordance with § 2133.02 of the Revised Code (§ 2133.01(F)).
Signing Requirements – Requires either the endorsements of at least two (2) witnessing parties or the certification of a notary public (§ 1337.12 & § 2133.02(B)).
Other Versions (2)
AARP (Caring Connections) Version
Download: Adobe PDF
Instructions: Adobe PDF
Prepare for Your Care Version (also available in Spanish/en Español)
Download: Adobe PDF
Multilingual Versions (5)
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Additional Resources
- Bazelon Center for Mental Health Law – Power in Planning
- Cleveland Clinic – Advance Directives Brochure
- LeadingAge Ohio – Living Well at the End of Life
- Midwest Care Alliance – Advance Directive Changes You Need to Know
- Midwest Care Alliance – Conversations That Light the Way
- Ohio Department of Medicaid – You Have the Right Pamphlet
- Pro Seniors – The Do-Not-Resuscitate DNR Order Law Pamphlet
Related Forms (7)
- Advance Directive Notification Letter
- Advance Directive Wallet Cards
- Appointment of Representative for Disposition of Bodily Remains, Funeral Arrangements, and Burial or Cremation Goods and Services
- Declaration For Funeral Arrangements (Disposition of Bodily Remains)
- Declaration for Mental Health Treatment
- Do-Not-Resuscitate (DNR) Form
- Durable (Financial) Power of Attorney
Advance Directive Notification Letter
Download: Adobe PDF
Advance Directive Wallet Cards
Download: Adobe PDF
Appointment of Representative for Disposition of Bodily Remains, Funeral Arrangements, and Burial or Cremation Goods and Services
Download: Adobe PDF
Declaration for Funeral Arrangements (Disposition of Bodily Remains)
Download: Adobe PDF
Declaration for Mental Health Treatment
Download: Adobe PDF
Download: Adobe PDF
Information: Adobe PDF
Wallet Card: Adobe PDF
Bracelet Insert: Adobe PDF
Durable (Financial) Power of Attorney
Download: Adobe PDF, MS Word (.docx)
Comments