An Ohio medical power of attorney is a written document in which you, the principal, name an agent to make health care decisions on your behalf. Ohio law sets rules for how it is signed and who may witness it or serve as your agent. The free Ohio medical power of attorney PDF below combines the appointment with an advance directive and has 21 fillable fields.
Last Updated: October 2026. This guide is reviewed and updated regularly to reflect current Ohio law. If you notice an error or outdated information, please contact us.
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An Ohio medical power of attorney lets you appoint a person you trust, called your agent, to make health care decisions for you. It is also known as an Ohio healthcare power of attorney, a health care power of attorney or a medical POA. The agent deals with doctors and hospitals on your behalf, and the powers are the ones written in the form you sign.
The FormsPal template is titled Ohio Medical Power of Attorney with Advance Directive. Part I names your agent and an alternate agent, Part II states end-of-life wishes, and Part III holds general provisions. For other documents, browse our Ohio power of attorney forms, or read how the medical power of attorney form works in general. For financial decisions rather than medical ones, see our Ohio general power of attorney or Ohio durable power of attorney form.
This guide covers the following topics, in the order of the page:
Ohio’s rules for a medical power of attorney sit in section 1337.12 of the Ohio Revised Code. They cover how it is signed, who may witness it, and who may serve as your agent. The sections below put each rule in plain words.[1]
It must be signed at the end by you, the principal, and it must state the date you signed it.[1]
… it shall be signed at the end of the instrument by the principal and shall state the date of its execution.
Ohio then gives two routes. You can have it witnessed by at least two adults, or you can sign it and have it acknowledged before a notary public.[1]
A notary must make the certification the statute describes. The notary must also attest that you appear to be of sound mind and not under or subject to duress, fraud, or undue influence.[1] FormsPal also has a separate notary acknowledgment template for Ohio.
Ohio limits who can witness it. The following people are ineligible to be your witnesses:
The same law limits who can be your agent. Your attending physician and an administrator of any nursing home in which you are receiving care cannot be named as your agent and cannot act as one.[1]
Pick an agent you trust and talk with that person before you name them. That is common practice, not an Ohio rule. Before you fill in the form, it helps to talk through a few points.
| Document Name | Ohio Medical Power of Attorney Form |
| FormsPal Template | Ohio Medical Power of Attorney with Advance Directive, seven pages |
| State Laws | Ohio Revised Code, Section 1337.12[1] |
| Signing Requirements | Two adult witnesses, or acknowledgment before a notary public[1] |
| Who Can’t Be the Agent? | Your attending physician or a nursing home administrator[1] |
| Who Can’t Be the Witness? | Relatives, a named agent, your attending physician or a nursing home administrator[1] |
| 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.
The FormsPal template has three parts, a signature page and a notary acknowledgment. What each part says comes from the printed text of the form, not from the statute. Read all seven pages before you sign.
If neither the agent nor the alternate agent can act, the form says one document must be attached. It can be a signed resignation, a physician’s written statement, a certified court order or a certified death certificate.
The advance directive is a serious statement about end-of-life care. If it does not match what you want, talk to a lawyer or your doctor before you sign. You can also compare it with our Ohio living will form. If you also want a do not resuscitate order, FormsPal has a separate Ohio DNR form.
The form has 21 fillable fields, all on pages 1, 6 and 7. The five steps below follow the form in order. Pages 2 to 5 are printed text with no blanks, so read them before you sign.
The screenshots under each step show the FormsPal Ohio medical power of attorney template filled with sample entries in blue, so you can see where each answer goes. The names, addresses, dates and amounts are examples only.
Filling in the blanks is only part of the job. The steps below cover what happens around the form, from getting the template to sharing copies. Ohio allows two routes, witnesses or a notary, so settle that before you print.
Most problems come from a few avoidable errors. Check this list against your finished form before you take it to a notary or ask anyone to witness it, because each item below comes straight from the Ohio rules or from the printed form.
The screenshots above use made-up entries so you can see where each answer goes. Nothing in the example below is a real person, address or date. Replace every entry with your own details before you sign.
These answers cover the witness and eligibility questions people ask most about the Ohio medical power of attorney. Each answer comes from section 1337.12 of the Ohio Revised Code, which sets the rules.
Not always. Ohio gives two routes. It may be witnessed by at least two adults, or it may be acknowledged before a notary public.[1] The FormsPal template includes a notary acknowledgment on page 7.
Yes, unless you use a notary. It must be witnessed by at least two individuals who are adults and who are not ineligible to be witnesses.[1]
Four groups of people are ineligible to be witnesses:
Your attending physician and a nursing home administrator cannot be named as your agent and cannot act as one.[1]
The notary makes the certification the statute describes. The notary also attests that you appear to be of sound mind and not under or subject to duress, fraud, or undue influence.[1]
Other Medical POA Forms by State
You can download the Ohio medical power of attorney as a PDF with 21 fillable fields, or build it online and print it. Either way, complete it in one of the two ways Ohio allows, with at least two adult witnesses or with an acknowledgment before a notary public.[1]
Here is what the download gives you:
General information, not legal or tax advice.
