Ohio Health Care Power of Attorney Form

Ohio Health Care Power of Attorney grants rights to appoint an agent to act on your behalf in good interest during healthcare decisions when you are unable to take them on your own due to unforeseen and/or whatsoever reasons. Please read the Notice to Adult Executing This Document carefully before proceeding with the signing and execution of the power of attorney. Attaching a copy of this notice with the power of attorney is mandatory by Ohio Revised Code § 1337.17.

The first two pages of the form describe various terms and definitions. The document clearly defines guidelines for agent and authorities as well. However, you must strike out authorities you do not wish to grant from the available 11 choices. Special Instructions in the form are essential and read them before signing with initials on option 3 to direct the agent to act upon certain instances. The Ohio Health Care Power Of Attorney Form sets five limitations to an agent. Space is provided for Limitations and/or Additional Instructions. Strike out all lines when you do not like to issue Additional Instructions. The Ohio Health Care Power of Attorney will not expire and grants powers to the agent to act as guardian when necessary. Either signature by two witnesses or notarization is necessary for the execution and legal standing of the Ohio Health Care Power of Attorney Form. You may opt to keep a copy of the document with the county recorder for safekeeping.

How to Fill the Ohio Health Care Power of Attorney Form

Commence with printing your name and date of birth in the foremost portion of the Ohio Health Care Power of Attorney. Mention the name, present address, and present phone number of the agent under the appointment in the space provided after explanation of terms and definitions. The next portion requires input of name, address, and telephone number of first and/or second alternate agent if you wish to appoint so. Otherwise, strike out blank lines to confirm non-appointment of alternate agent.

Sign with initials in the option 3 to grant rights to the designated agent for decision-making during the conditions and/or circumstances mentioned under Special Instructions.

The next portion of Additional Instructions or Limitations is a space for granting or withdrawing additional rights of an agent and it needs input of directives. Strike out all remaining blank lines or write none in the absence of issuance of instructions or limitations.

Mark your choice between Yes or No for three subsections requiring inputs of your decision on Living Will, Anatomical Gift(s), and Donor Registry Enrollment Form. Your signature along with the date in the prescribed format and name of the county is required in the respective spaces provided.

Fill the details of two witnesses, if you prefer it over to notarization. Both witnesses must mention the address, their printed name, date, and sign on the spaces provided. Alternately, notarization is required if you prefer it over to signatures by two witnesses. Notary Public of Ohio State is authorized to notarize the Ohio Health Care Power of Attorney for its legal effectiveness. Mention name of the county, date, name of the signing principle, along with seal and signature as well as date of expiry of the commission.

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Ohio Health Care Power of Attorney Form