Ohio Medical Power of Attorney (POA) Form

Health Care Power of Attorney is a type of legal document that grants another person with the right to make health care decisions for the principal (an initial author of the document) in cases when it is medically proved that the principal is no longer capable of making such decisions for themselves. Such medical statements are made by an attending physician. If a physician states that his client (the principal) at some point became incapable of making his own rational decisions, the power of attorney directive for health care comes into force and authorizes the assigned agent to act on behalf of the principal in terms of taking responsibility for the principal’s health care decisions as stationed in the document.

To initiate a Durable Health Care Power of Attorney, one must be a competent adult of eighteen years of age and older. The process of creating and validating the medical power of attorney form must be fully voluntary. No other person can have it filled out and signed for the principal or make the principal create such a document against their own will.

Ohio power of attorney templates – read more about powers of attorney for different things in the State of Ohio.

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The Durable Healthcare Power of Attorney may authorize the attorney right after the form is signed or at any time after; the principal may or may not be incapacitated of making informed healthcare decisions or obtaining information on the principal’s health.

The Durable HPA may also authorize the agent to have the right to give or refusing to give informed consent or to withdraw informed consent to any healthcare that the principal may be offered.

Validating the Healthcare Power of Attorney

There are two conditions that a power of attorney must satisfy to be validated:

  • it must be signed by the principal with the date of execution stated;
  • it must be witnessed or be acknowledged by the principal according to divisions B and C of the state of Ohio Revised Code (Title XIII, Chapter 1337, Section 1337.12).

Ohio Laws and Requirements

The legal terms below are defined according to §1337 of the state of Ohio Revised Code:

  • Adult: a person of eighteen years of age or older;
  • Principal: an adult person who is competent to sign an HPA form;
  • Agent (or attorney-in-fact): an adult person receiving the right to make healthcare decisions on behalf of the principal.
  • Health care: a various range of medical measures and procedures for maintaining or treating one’s physical or mental health.
  • Health care decision: a decision to provide, refuse, or stop medical treatment of an individual.
  • Health Care Power of Attorney (HPA): a legal document that will let the principal choose and authorize an attorney-in-fact (or agent) to make healthcare decisions in cases when the principal is rendered incapable of making such decisions. HPA will also allow the chosen agent to receive medical information for or on behalf of the principal.

Ohio Medical Power of Attorney Form Details

Document Name Ohio Medical Power of Attorney Form
State Form Name Ohio Health Care Power of Attorney
State Laws Ohio Revised Code, Sections 1337.11 to 1337.17
Signing Requirements Notary Public OR Two Witnesses
Who Can’t Be the Agent? Section 1337.12(A)(2)
Who Can’t Be the Witness? Section 1337.12(B)
Avg. Time to Fill Out 8 minutes
# of Fillable Fields 21
Available Formats Adobe PDF

Popular Local Medical POA Forms

Health care power of attorney forms are used in every state. Have a look at other samples of Medical POA forms regularly filled out by people.

Filling out the HPA form

You can use our form building software to significantly simplify the process. If you want to complete the HPA form yourself and make it legit, make sure to follow the detailed instruction below:

  • Obtain the template

Download the form for Ohio HP.

  • Provide Personal Data

Write your full name and date of birth on the first page of the document.
Personal data part of Ohio mpoa template

  • Name Your Agent

Write the full name of your attorney-in-fact (agent) and your relationship. Submit your agent’s address and a telephone number. According to the state of Ohio law, your agent must be a competent adult person of 18 years of age or older.
Agent indication section of medical poa for Ohio

  • Allow Your Agent to Receive Your Health Information

Authorize your lawful representative to obtain your health information by adding your initials or another mark in the box below the agent’s personal information section.
Part for allowing to receive health information of Ohio medical power of attorney document

  • Name Your Alternate Agent

Name your alternate representative by submitting the alternate agent’s personal data: full name and your relationship, address, and telephone number. Keep in mind that you may choose up to two alternate agents.   An alternate agent(s) section is a safety measure for cases when your primary agent is not ready, capable, or willing to perform the duties listed in the document.
Alternate agent indication part of Ohio mpoa

  • Authorize Your Agent

Grant your agent full authority within the listed duties to provide you with health care under the circumstances stationed by the document. Put your initials or another mark in the box below the “Authority of Agent” section.
Agent Authorization section of Ohio medical power of attorney

  • Add Extra Instructions or Limitations

If you have any additional instructions or limitations for your agent(s), make sure to write them in the responsive box. If you don’t have any, just write, “None.”
Extra instructions or limitations adding section of medical poa document for Ohio

  • Name Your Guardian

You may also choose a guardian for yourself or your property. A guardian is an adult person that may take care of you or your property if there is a need to. Usually, guardians are appointed by the court, but you can choose them yourself and list them in the special section of HPA. Guardians only take care of you in terms of day-to-day routine (food, clothing, living conditions, etc.). Your health care is still regulated by the HPA and your attorney-in-fact that you authorize with the said document.

To choose your guardian, insert the guardian’s full name and your relationship, address, and telephone number. You are able to assign two guardians.

The HPA also allows you to assign your agent or alternate agent(s) as your guardians. To do this, put your initials in the box below the “Nomination of Guardian” section.
Guardian identification part of Ohio HPA form

  • Sign the Document

Check all the information you’ve given and then proceed with the signing of the document. Put your signature and insert the date.
Signing part of medical power of attorney for Ohio

  • Witness the Form or Make Notary Acknowledge for It

To witness the document, you will need two adult witnesses who shall put their signatures next to their printed names in the “Witnesses” section. You primary and alternate agents, your guardians, youк blood relatives or anyone related to you by marriage or adoption, your physician, or the manager of a nursing home where you might be receiving care CANNOT be your witnesses.

To make notary acknowledgment for the document, you will need to have it proved legit by a notary public.
Witness or notarization section of Ohio medical power of attorney form

seal of ohio state

Other Ohio Forms

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Published: Nov 20, 2020