How to Fill Out and Sign an Ohio Medical Power of Attorney

An Ohio medical power of attorney lets you name someone to make healthcare decisions for you if a doctor determines you can’t make them yourself. Any Ohio adult of sound mind can create one by filling out the statutory form, signing it either before a notary or two qualified witnesses, and giving copies to the people who will need them. No court filing, lawyer, or fee is required beyond a small notary charge, and the document is governed by Ohio Revised Code sections 1337.11 through 1337.17.

Who Can Create One and Who Can Serve as Agent

You must be at least 18 and of sound mind to execute the form.¹ Sound mind means you understand what the document does, who you’re naming, and the kinds of decisions that person could make. A mental illness diagnosis, or even having a legal guardian, does not automatically disqualify you.²

Your agent (the statute calls this person your “attorney-in-fact”) can be any competent adult.¹ Family is not required, and sometimes a non-family member is the better choice when relatives are likely to disagree about treatment. Pick someone who knows your values around medical care and will advocate firmly under pressure. Then name at least one successor in case your first choice is unavailable, unwilling, or unable to serve when the time comes. Without an alternate, a single unreachable agent can make the whole document useless.

Where to Get the Form

Ohio does not require one official version, but the document must substantially comply with ORC 1337.12.¹ The template most people use is the printed form set out in ORC 1337.17, which already contains the required disclosures and check-boxes. You can download it from the Ohio State Bar Association³ or from Ohio Legal Help, a free service run by the state’s legal aid organizations.⁴

Filling It Out

Your Information and Your Agent

Print your full legal name, address, and date of birth. Do the same for your primary agent, and include a phone number where they can actually be reached quickly. A cell number beats a work line. Add the same identifying details for each successor agent.

Scope of Authority

Under ORC 1337.13, your agent can make a healthcare decision only if the document specifically authorizes that power.⁵ A blank or unchecked section can leave your agent without legal standing to act in that area. The statutory form includes separate check-boxes for the two decisions that generate the most dispute:⁶

Authority to refuse or withdraw life-sustaining treatment. This power activates only after your attending physician and one additional physician determine, to a reasonable degree of medical certainty, that you have an irreversible, incurable, and untreatable condition or are in a state of permanent unconsciousness.
Authority to refuse artificially administered nutrition and hydration. Your agent can use this power only when physicians determine that nutrition or hydration will no longer provide comfort or alleviate pain.

Read both carefully and talk through them with your agent before you check anything. A checked box carries the full statutory weight above.

Comfort Care and Personal Instructions

Ohio law defines comfort care as nutrition, hydration, or any other medical measure taken to reduce pain or discomfort, not to postpone death.⁷ Even if you authorize your agent to decline life-sustaining treatment, the form lets you confirm that you still want comfort care, including pain relief and basic hygiene. Most people check this box, and doing so explicitly keeps anyone from second-guessing your agent’s requests for pain medication.

The form also leaves room for personalized instructions. Common additions:

Organ and tissue donation preferences, including any limits on which organs or tissues.
Religious or philosophical refusals, such as declining blood transfusions.
Mental health treatment direction. The healthcare POA covers mental health treatment as a category, but a separate declaration executed under ORC Chapter 2135 will supersede the healthcare POA on mental health matters specifically.⁷

Be as specific as you can. Your agent is legally required to follow your known wishes, and to act in your best interest only when your wishes are unknown.⁵ “Do what you think is right” pushes a hard judgment call onto your agent that clearer language could have resolved.

Signing the Form

Your Ohio healthcare power of attorney is not valid until it is properly executed. You have two options, and you only need one.¹

Notarization

Sign the form and acknowledge your signature before a notary public. This is the simpler path and the one hospitals accept with the least fuss. Ohio notary fees are modest, typically under $10 for a single acknowledgment.

Two Witnesses

If you skip the notary, sign the form (or acknowledge your signature) in front of two adult witnesses. Ohio disqualifies several categories of people from witnessing:¹

Your named agent or any alternate agent in the document.
Anyone related to you by blood, marriage, or adoption.
Your attending physician.
The administrator of any nursing home where you are receiving care.

The ban on relatives applies to both witnesses, not just one. A common mistake is grabbing two family members to witness the signing; both must be unrelated to you. Coworkers, neighbors, or unrelated friends are typical choices.

Whichever method you choose, sign at the end of the document and date it.¹

When the Document Takes Effect

Your agent has no authority to make medical decisions for you until your attending physician formally determines you have lost the capacity to make informed healthcare decisions yourself.⁶ Until then, you keep full control over your own care. If you later regain capacity, your authority resumes and the agent’s authority pauses.

Decisions to withdraw life-sustaining treatment require a higher showing: your attending physician plus at least one additional physician must examine you and conclude, to a reasonable degree of medical certainty, that you have an irreversible, incurable, and untreatable condition or are in a state of permanent unconsciousness.⁶ A single doctor’s opinion is not enough for those decisions.

Who Should Get Copies

Ohio does not require you to file this form with any court or government agency.¹ Its power depends entirely on the right people having a copy at the right moment. Distribute copies to:

Your agent and each successor, who will need to present the document to hospital staff.
Your primary care physician, so the office can scan it into your electronic medical record.
Any hospital or facility where you receive regular care or have upcoming procedures. Many systems let you upload advance directives through a patient portal.

Keep the original somewhere accessible. A fireproof home filing cabinet or a clearly labeled folder that your agent knows about works well. Avoid a safe deposit box, which no one may be able to open in an emergency. Review the document every few years, or after any major life change such as a move, a new diagnosis, or a divorce.

Changing or Revoking the Document

You can revoke your healthcare power of attorney at any time and in any manner: written, oral, or by physically destroying the document.⁸ The revocation is effective the moment you express the intent to revoke, with one key exception: if your attending physician already knows about the healthcare POA, the revocation only takes effect once someone communicates it to that physician. Telling a family member you changed your mind may not be enough if your doctor’s office still has the old form on file. Notify your physician directly, or have someone do it for you.

Creating a new healthcare power of attorney automatically revokes any prior one, unless the earlier document says otherwise.⁸ After revoking, collect and destroy the copies you handed out, and send written notice to the former agent and any provider holding the old version.

Divorce Automatically Ends a Spouse’s Authority

If you named your spouse as your agent and later file for divorce, dissolution, or legal separation, your spouse’s authority as agent terminates when the action is filed, not when the divorce is finalized, unless your document specifically says otherwise.⁹ If you want your spouse to continue serving during the divorce, you must address that in the document. Otherwise, execute a new healthcare POA naming someone else as soon as the filing occurs.

If You Travel Outside Ohio

There is no single federal law requiring every state to recognize another state’s advance directives, though many states have adopted some version of the Uniform Health-Care Decisions Act, which encourages reciprocal recognition.¹⁰ In practice, most hospitals will try to honor a clear, properly executed out-of-state document. Carry a copy when you travel, and have your agent carry one as well. If you split time between Ohio and another state, consider executing a healthcare POA that complies with each state’s requirements.

1
Ohio Legislative Service Commission. Ohio Code 1337.12 – Formality of Execution
2
Disability Rights Ohio. Advance Directives for Mental Health Treatment in Ohio – Power of Attorney
3
Ohio State Bar Association. Ohio Health Care Power of Attorney
4
Ohio Legal Help. Durable Healthcare Power of Attorney
5
Ohio Legislative Service Commission. Ohio Code 1337.13 – Authority of Attorney in Fact Under a Durable Power of Attorney for Health Care
6
Ohio Legislative Service Commission. Ohio Code 1337.17 – Printed Form – Durable Power of Attorney for Health Care
7
Ohio Legislative Service Commission. Ohio Code 1337.11 – Durable Power of Attorney for Health Care Definitions
8
Ohio Legislative Service Commission. Ohio Code 1337.14 – Revocation of Durable Power of Attorney for Health Care
9
Ohio Legislative Service Commission. Ohio Code 1337.30 – Termination of Power of Attorney or Agent’s Authority
10
Uniform Law Commission. Health-Care Decisions Act