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Free Ohio Medical Power of Attorney Form

An Ohio medical power of attorney is a durable power of attorney for health care that names your attorney in fact. Build yours with our guided form and follow Ohio's signing rules step by step.

  • Download as PDF and Word
  • E-sign included

How It Works

1

Select Your Template

Choose the state or form type you need to start.

2

Fill In Your Details

Answer a few simple questions to customize your form.

3

Get Your Form

Download or print your custom document in PDF or Word.

What Is a Medical Power of Attorney in Ohio?

Ohio calls this a durable power of attorney for health care under Ohio Revised Code § 1337.12. An adult of sound mind can use one to authorize an attorney in fact to make health care decisions once the attending physician finds the adult has lost the capacity to make them.

Ohio Formalities Under R.C. 1337.12

Ohio sets out exactly how the document must be executed.

Sign at the End and Date It

Your Ohio medical power of attorney must be signed at the end of the instrument and state the date you signed it.

Witnesses or a Notary

You then have your Ohio medical power of attorney either witnessed by two eligible adults or acknowledged before a notary.

Who Cannot Witness

These people are ineligible to witness:

  • Anyone related to you by blood, marriage, or adoption
  • Your attorney in fact or alternate attorney in fact
  • Your attending physician
  • The administrator of any nursing home where you are receiving care

How Witnessing Works

You sign, or acknowledge your signature, at the end of the document in each witness’s presence. Each witness then signs after your signature.

Does an Ohio Medical Power of Attorney Expire?

No, not unless you choose an expiration date. Ohio says a durable power of attorney for health care does not expire unless you specify one.

If you do set an expiration date and you lack capacity to make informed health care decisions on that date, the document stays in effect. It continues until you regain that capacity.

Health Information Can Start Now

Ohio lets your document authorize your attorney in fact to obtain your health information right away, even before you lose capacity. That includes protected health information under federal privacy rules, which can help your agent prepare.

How to Sign Your Ohio Medical Power of Attorney

Work through your Ohio medical power of attorney form in this order:

  1. Name your attorney in fact and an alternate.
  2. Decide whether they can get your health information immediately.
  3. Add any expiration date or limits you want.
  4. Sign at the very end of the document and write the date.
  5. Have two eligible adults witness it, or acknowledge it before a notary.
  6. Share copies with your attorney in fact and doctors.

What to Include in Your Ohio Form

Ohio generally bars employees and agents of your attending physician, or of a facility treating you, from serving as attorney in fact. Relatives are the exception, as are members of the same religious order. A well-prepared Ohio document includes:

  • Your attorney in fact and an alternate
  • Any authorization to obtain health information immediately
  • Any limits or instructions on treatment
  • An expiration date, if you want one
  • A nomination of a guardian, if you choose

Ohio’s living will is a separate document called a declaration.