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Other Names: Ohio Healthcare POA Ohio Healthcare Power of Attorney Ohio Medical POA Ohio Healthcare Proxy
Ohio Medical Power of Attorney document preview

What is an Ohio Medical Power of Attorney?

An Ohio Medical Power of Attorney is a legal document that grants a person or entity the authority to make health-related decisions on your behalf, such as requesting or refusing specific medical treatments and procedures, when you cannot do so. 
 
The individual granting control is called the "principal," and the person or organization receiving powers is known as the "agent." Suitable for Ohio residents, this Power of Attorney for health care is made for use in Cuyahoga County, Hamilton County, Summit County, and in every other part of the state. All Ohio Medical PoA forms from Rocket Lawyer can be modified for your specific scenario. This official document provides proof to healthcare institutions and other parties that your chosen agent is legally allowed to act in your interest.

When to use an Ohio Medical Power of Attorney:

  • You want to play it safe and know who's in charge of your healthcare if you're incapacitated.
  • You've been diagnosed with a terminal illness or are otherwise concerned about your health.

Sample Ohio Medical Power of Attorney

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NOTICE TO ADULT EXECUTING THIS DOCUMENT

 

This is an important legal document. Before executing this document, you should know these facts:

 

This document gives the person you designate (the Attorney-in-Fact) the power to make MOST health care decisions for you if you lose the capacity to make informed health care decisions for yourself. This power is effective only when your attending physician determines that you have lost the capacity to make informed health care decisions for yourself and, notwithstanding this document, as long as you have the capacity to make informed health care decisions for yourself, you retain the right to make all medical and other health care decisions for yourself. This document may also authorize your Attorney-in-Fact to obtain information about your health, including protected health information.

 

You may include specific limitations in this document on the authority of the Attorney-in-Fact to make health care decisions for you.

 

Subject to any specific limitations you include in this document, if your attending physician determines that you have lost the capacity to make an informed decision on a health care matter, the Attorney-in-Fact GENERALLY will be authorized by this document to make health care decisions for you to the same extent as you could make those decisions yourself, if you had the capacity to do so. The authority of the Attorney-in-Fact to make health care decisions for you GENERALLY will include the authority to give informed consent, to refuse to give informed consent, or to withdraw informed consent to any care, treatment, service, or procedure to maintain, diagnose, or treat a physical or mental condition.

 

HOWEVER, even if the Attorney-in-Fact has general authority to make health care decisions for you under this document, the Attorney-in-Fact NEVER will be authorized to do any of the following:

 

(1) Refuse or withdraw informed consent to life-sustaining treatment (unless your attending physician and one other physician who examines you determine, to a reasonable degree of medical certainty and in accordance with reasonable medical standards, that either of the following applies:

 

(a) You are suffering from an irreversible, incurable and untreatable condition caused by disease, illness, or injury from which (i) there can be no recovery and (ii) your death is likely to occur within a relatively short time if life-sustaining treatment is not administered, and your attending physician additionally determines, to a reasonable degree of medical certainty and in accordance with reasonable medical standards, that there is no reasonable possibility that you will regain the capacity to make informed health care decisions for yourself.

 

(b) You are in a state of permanent unconsciousness that is characterized by you being irreversibly unaware of yourself and your environment and by a total loss of cerebral cortical functioning, resulting in you having no capacity to experience pain or suffering, and your attending physician additionally determines, to a reasonable degree of medical certainty and in accordance with reasonable medical standards, that there is no reasonable possibility that you will regain the capacity to make informed health care decisions for yourself);

 

(2) Refuse or withdraw informed consent to health care necessary to provide you with comfort care (except that, if the Attorney-in-Fact is not prohibited from doing so under (4) below, the Attorney-in-Fact could refuse or withdraw informed consent to the provision of nutrition or hydration to you as described under (4) below). (YOU SHOULD UNDERSTAND THAT COMFORT CARE IS DEFINED IN OHIO LAW TO MEAN ARTIFICIALLY OR TECHNOLOGICALLY ADMINISTERED SUSTENANCE (NUTRITION) OR FLUIDS (HYDRATION) WHEN ADMINISTERED TO DIMINISH YOUR PAIN OR DISCOMFORT, NOT TO POSTPONE YOUR DEATH, AND ANY OTHER MEDICAL OR NURSING PROCEDURE, TREATMENT, INTERVENTION, OR OTHER MEASURE THAT WOULD BE TAKEN TO DIMINISH YOUR PAIN OR DISCOMFORT, NOT TO POSTPONE YOUR DEATH. CONSEQUENTLY, IF YOUR ATTENDING PHYSICIAN WERE TO DETERMINE THAT A PREVIOUSLY DESCRIBED MEDICAL OR NURSING PROCEDURE, TREATMENT, INTERVENTION, OR OTHER MEASURE WILL NOT OR NO LONGER WILL SERVE TO PROVIDE COMFORT TO YOU OR ALLEVIATE YOUR PAIN, THEN, SUBJECT TO (4) BELOW, YOUR ATTORNEY-IN-FACT WOULD BE AUTHORIZED TO REFUSE OR WITHDRAW INFORMED CONSENT TO THE PROCEDURE, TREATMENT, INTERVENTION, OR OTHER MEASURE.);

 

(3) Refuse or withdraw informed consent to health care for you if you are pregnant and if the refusal or withdrawal would terminate the pregnancy (unless the pregnancy or health care would pose a substantial risk to your life, or unless your attending physician and at least one other physician who examines you determine, to a reasonable degree of medical certainty and in accordance with reasonable medical standards, that the fetus would not be born alive);

 

(4) REFUSE OR WITHDRAW INFORMED CONSENT TO THE PROVISION OF ARTIFICIALLY OR TECHNOLOGICALLY ADMINISTERED SUSTENANCE (NUTRITION) OR FLUIDS (HYDRATION) TO YOU, UNLESS:

 

(a) YOU ARE IN A TERMINAL CONDITION OR IN A PERMANENTLY UNCONSCIOUS STATE.

 

(b) YOUR ATTENDING PHYSICIAN AND AT LEAST ONE OTHER PHYSICIAN WHO HAS EXAMINED YOU DETERMINE, TO A REASONABLE DEGREE OF MEDICAL CERTAINTY AND IN ACCORDANCE WITH REASONABLE MEDICAL STANDARDS, THAT NUTRITION OR HYDRATION WILL NOT OR NO LONGER WILL SERVE TO PROVIDE COMFORT TO YOU OR ALLEVIATE YOUR PAIN.

 

(c) IF, BUT ONLY IF, YOU ARE IN A PERMANENTLY UNCONSCIOUS STATE, YOU AUTHORIZE THE ATTORNEY-IN-FACT TO REFUSE OR WITHDRAW INFORMED CONSENT TO THE PROVISION OF NUTRITION OR HYDRATION TO YOU BY DOING BOTH OF THE FOLLOWING IN THIS DOCUMENT:

 

(i) INCLUDING A STATEMENT IN CAPITAL LETTERS OR OTHER CONSPICUOUS TYPE INCLUDING, BUT NOT LIMITED TO, A DIFFERENT FONT, BIGGER TYPE, OR BOLD FACE TYPE, THAT THE ATTORNEY-IN-FACT MAY REFUSE OR WITHDRAW INFORMED CONSENT TO THE PROVISION OF NUTRITION OR HYDRATION TO YOU IF YOU ARE IN A PERMANENTLY UNCONSCIOUS STATE AND IF THE DETERMINATION THAT NUTRITION OR HYDRATION WILL NOT OR NO LONGER WILL SERVE TO PROVIDE COMFORT TO YOU OR ALLEVIATE YOUR PAIN IS MADE, OR CHECKING OR OTHERWISE MARKING A BOX OR LINE (IF ANY) THAT IS ADJACENT TO A SIMILAR STATEMENT ON THIS DOCUMENT;

 

(ii) PLACING YOUR INITIALS OR SIGNATURE UNDERNEATH OR ADJACENT TO THE STATEMENT, CHECK, OR OTHER MARK PREVIOUSLY DESCRIBED.

 

(d) YOUR ATTENDING PHYSICIAN DETERMINES, IN GOOD FAITH, THAT YOU AUTHORIZED THE ATTORNEY-IN-FACT TO REFUSE OR WITHDRAW INFORMED CONSENT TO THE PROVISION OF NUTRITION OR HYDRATION TO YOU IF YOU ARE IN A PERMANENTLY UNCONSCIOUS STATE BY COMPLYING WITH THE REQUIREMENTS OF (4)(c)(i) AND (ii) ABOVE.

 

(5) Withdraw informed consent to any health care to which you previously consented, unless a change in your physical condition has significantly decreased the benefit of that health care to you, or unless the health care is not, or is no longer, significantly effective in achieving the purposes for which you consented to its use.

 

Additionally, when exercising authority to make health care decisions for you, the Attorney-in-Fact will have to act consistently with your desires or, if your desires are unknown, to act in your best interest. You may express your desires to the Attorney-in-Fact by including them in this document or by making them known to the Attorney-in-Fact in another manner.

 

When acting pursuant to this document, the Attorney-in-Fact GENERALLY will have the same rights that you have to receive information about proposed health care, to review health care records, and to consent to the disclosure of health care records. You can limit that right in this document if you so choose.

 

Generally, you may designate any competent adult as the Attorney-in-Fact under this document. However, you CANNOT designate your attending physician or the administrator of any nursing home in which you are receiving care as the Attorney-in-Fact under this document. Additionally, you CANNOT designate an employee or agent of your attending physician, or an employee or agent of a health care facility at which you are being treated, as the Attorney-in-Fact under this document, unless either type of employee or agent is a competent adult and related to you by blood, marriage, or adoption, or unless either type of employee or agent is a competent adult and you and the employee or agent are members of the same religious order.

 

This document has no expiration date under Ohio law, but you may choose to specify a date upon which your Durable Power of Attorney for Health Care generally will expire. However, if you specify an expiration date and then lack the capacity to make informed health care decisions for yourself on that date, the document and the power it grants to your Attorney-in-Fact will continue in effect until you regain the capacity to make informed health care decisions for yourself.

 

You have the right to revoke the designation of the Attorney-in-Fact and the right to revoke this entire document at any time and in any manner. Any such revocation generally will be effective when you express your intention to make the revocation. However, if you made your attending physician aware of this document, any such revocation will be effective only when you communicate it to your attending physician, or when a witness to the revocation or other health care personnel to whom the revocation is communicated by such a witness communicate it to your attending physician.

 

If you execute this document and create a valid Durable Power of Attorney for Health Care with it, it will revoke any prior, valid Durable Power of Attorney for Health Care that you created, unless you indicate otherwise in this document.

 

This document is not valid as a Durable Power of Attorney for Health Care unless it is acknowledged before a Notary Public or is signed by at least two adult witnesses who are present when you sign or acknowledge your signature. No person who is related to you by blood, marriage, or adoption may be a witness. The Attorney-in-Fact, your attending physician, and the administrator of any nursing home in which you are receiving care also are ineligible to be witnesses.

 

If there is anything in this document that you do not understand, you should ask your lawyer to explain it to you.

 

DURABLE POWER OF ATTORNEY FOR HEALTH CARE

 

 

. DESIGNATION OF HEALTH CARE AGENT. I, , of , , intend to create a Durable Power of Attorney for Health Care. I hereby appoint:

 

Agent Name:

 

Agent Address:

  ,

Phone: Home: Work:

Relation, if any:

 

to be my health care Agent (Attorney-in-Fact) to make health care decisions for me as authorized in this document.

 

. STATEMENT OF AUTHORITY GRANTED. Subject to any limitations in this document, I grant to my Agent full power and authority to make health care decisions for me to the same extent that I could make such decisions for myself if I had the capacity to do so. In exercising this authority, my Agent shall have the authority to give, to withdraw or to refuse to give informed consent to any medical or nursing procedure or treatment. In exercising this authority, my Agent shall make health care decisions that are consistent with my desires as stated in this document or otherwise made known to my Agent, or if I have not made my desires known, my Agent shall act in my best interests.

 

If I am in a terminal condition, my Agent has the power and authority to refuse or withdraw informed consent to life-sustaining treatment;

 

If I am in a permanently unconscious state, my Agent has the power and authority to withdraw or to refuse to give informed consent to life-sustaining treatment. My agent is not authorized to refuse or direct the withdrawal of artificially or technologically administered nutrition or hydration unless I have specifically authorized such withdrawal or withholding in this document;

 

SECOND ALTERNATE AGENT

 

Agent Name:

 

Agent Address:

  ,

Phone: Home: Work:

Relation, if any:

 

. DURATION. This power is effective only when my attending physician determines that I have lost the capacity to make informed health care decisions. This Durable Power of Attorney for Health Care shall not be affected by my disability or by lapse of time, and shall continue indefinitely or until it is revoked.

 

. HOLD HARMLESS. All persons or entities who in good faith endeavor to carry out the terms and provisions of this document shall not be liable to me, my estate, my heirs or assigns for any damages or claims arising because of their action or inaction based on this document, and my estate shall defend and indemnify them.

 

. SEVERABILITY. If any provision of this document is held to be invalid, such invalidity shall not affect the other provisions which can be given effect without the invalid provision, and to this end the directions in this document are severable.

 

. STATEMENT OF INTENTIONS. It is my intent that this document be legally binding and effective. If the law does not recognize this document as legally binding and effective, it is my intent that this document be taken as a formal statement of my desire concerning the method by which any health care decisions should be made on my behalf during any period in which I am unable to make such decisions.

 

By my signature I indicate that I understand the purpose and effect of this document, after careful reflection, while I am of sound mind, I execute this Durable Power of Attorney for Health Care on the ______ day of ____________________, _____.

 

 

 

Signature: ________________________________________

 

Principal Name:

Address:

  County

 

A notary public

two witnesses who then sign the document in your presence and in each other's presence.a notary who then notarizes the document.

Ohio Medical Power of Attorney FAQs

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  • Where can I get Medical Power of Attorney in Ohio?

    It's fast and simple to assign or receive the support you may need with a free Ohio Medical Power of Attorney template from Rocket Lawyer:

    1. Make the document - Provide a few details and we will do the rest
    2. Send and share - Discuss the document with your agent or ask a lawyer
    3. Sign and make it legal - Optional or not, notarization and witnesses are recommended

    This solution, in many cases, would be notably less time-consuming than finding and working with your average provider. If necessary, you may fill out a Medical PoA on behalf of your spouse, an elderly parent, or another relative, and then help that person sign after you've drafted it. Please note that for this document to be considered valid, the principal must be a mentally competent adult when they sign. In the event that the principal is already incapacitated and unable to make their own decisions, a conservatorship may be required. When dealing with this situation, it would be a good idea for you to work with a lawyer .

  • Why should I have a Power of Attorney for healthcare in Ohio?

    If you are over 18 years old, you should have a Medical Power of Attorney. Although it can be difficult to think about, a day might come when you can no longer make your own healthcare decisions. Here are some typical situations where you may find a PoA to be helpful:

    • You are planning for an upcoming medical procedure or a hospitalization
    • You are getting older or dealing with ongoing health issues
    • You've been diagnosed with a terminal condition
    • You are preparing to move into a community care facility

    Regardless of whether this Ohio Medical Power of Attorney is being generated as part of a long-term plan or produced in response to an unexpected issue, witnesses and notarization are highly encouraged for protecting your agent if their privileges and authority are doubted.

  • What are the differences between an Ohio Healthcare Proxy and an Ohio Medical Power of Attorney?

    Sometimes, in discussing the subjects of estate planning and/or elder care with legal or medical professionals, you may hear the terms "healthcare power of attorney", "medical power of attorney" and "healthcare proxy" used together or interchangeably. At the end of the day, they are the same. That said, you should keep in mind that it's entirely possible to give power of attorney over matters that are not related to health care. In that case, "proxy" is not typically used.

  • Should I work with an attorney for my Ohio Medical PoA?

    Ohio Medical PoA forms are normally straightforward; however, you or your agent could have legal questions. The answer will depend on whom you approach, but sometimes a lawyer may not even agree to review your document if they weren't the author. A more favorable approach might be to request help from the On Call network. When you sign up for a Premium membership, you can request feedback from an experienced lawyer or send additional legal questions related to your Medical Power of Attorney. As always, Rocket Lawyer is here to help.

  • What might it typically cost for an attorney to help me get a Power of Attorney form for health care in Ohio?

    The fees associated with working with your average attorney to generate a Medical Power of Attorney could total anywhere from $200 to $500, depending on your location. When using Rocket Lawyer, you aren't just filling out a Power of Attorney template. If you ever require support from a lawyer, your Premium membership offers up to a 40% discount when you hire an attorney from our Rocket Lawyer attorney network.

  • Will I have to do anything else once I make an Ohio Medical Power of Attorney?

    Upon finishing a document, you can see it wherever and whenever you choose. You also can engage with the document in all of these ways: making edits, saving it as a Word document or PDF file, printing it, and signing it. Your Power of Attorney will come with a checklist of recommended actions you can take to finalize the document. You will need to give a copy of your fully signed document to your agent(s), care providers, and other impacted parties.

  • Does a Medical Power of Attorney need to be notarized, witnessed, or recorded in Ohio?

    The guidelines and restrictions governing PoA forms are different by state; however, in Ohio, your Power of Attorney will require the signatures of two witnesses or a notary public. Witnesses to this PoA cannot be your attending physician or an administrator of the nursing home where you reside, or spouse, adoptee, or other relative. As a basic rule, witnesses should be 18 years old or older, and none of them should also be your Power of Attorney agent.

    See Ohio Medical/Healthcare Power of Attorney law: § 1337.13

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