The Power Of Attorney For Health Care is the Ohio Health Care Power of Attorney form that the Summit County Fiscal Office publishes on its forms page, next to its Summit County property tax forms and other county records forms. In it, an adult (the principal) names an agent to make health care decisions if the principal cannot make them. The form becomes valid only when it is signed before two eligible witnesses or acknowledged before a notary public. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the original is published by the Summit County Fiscal Office.
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What is Power Of Attorney For Health Care – Ohio?
The Power Of Attorney For Health Care is the Ohio Health Care Power of Attorney form, published by the Summit County Fiscal Office, in which an adult (the principal) names an agent to make health care decisions if the principal becomes unable to do so.
The printed document is titled "Health Care Power of Attorney" and runs 11 pages. It has the principal's name and birth date, the agent and alternate agents, a list of the authority the agent holds, a special instruction about artificially or technologically supplied nutrition or hydration, the limits Ohio law places on an agent, space for additional instructions, and yes/no statements about a Living Will, anatomical gifts and the Donor Registry Enrollment Form. It ends with the principal's signature and either a witness block or a notary acknowledgment.
The form says it is in effect only when you cannot make health care decisions for yourself, and that this does not require a court to declare you incompetent. It has no expiration date and is not affected by your disability or the passage of time. The county's forms page describes it as a legal declaration that cannot be recorded unless two eligible witnesses signed it or a notary public acknowledged it, and cites O.R.C. §1337.12. The notice printed inside the form is included as required by Ohio Revised Code § 1337.17.
It is not a Living Will. A Living Will is a separate document in which you state the health care you want if you become terminally ill or permanently unconscious; the county lists it as its own form.
Who needs to file Power Of Attorney For Health Care – Ohio?
An adult who wants to name another adult to make health care decisions for them if they lose the ability to do so completes this form as the principal. The Ohio notice printed in the form says you keep the right to make your own health care decisions for as long as you have the capacity to do so.
Choosing an agent. Generally you may name any competent adult. You cannot name your attending physician or the administrator of a nursing home where you receive care. You also cannot name an employee or agent of your attending physician, or of a health care facility treating you, unless that person is a competent adult related to you by blood, marriage or adoption, or is a competent adult in the same religious order as you.
Choosing witnesses. If you use witnesses instead of a notary, you need two adults who are present when you sign or acknowledge your signature. These people cannot witness: the agent, any successor agent, your spouse, your children, anyone else related to you by blood, marriage or adoption, your attending physician, or, if you live in a nursing home, its administrator.
You do not have to name alternate agents. The form also says that if you have questions about anything in it, you should ask your lawyer to explain it.
When to file Power Of Attorney For Health Care – Ohio
Complete this form when you decide to name an agent for your health care decisions; it has no due date. It takes effect only when you cannot make health care decisions for yourself, and it has no expiration date and is not affected by the passage of time. The Ohio notice in the form adds that you may choose to specify an expiration date, but if you lose capacity on that date, the document stays in effect until you regain capacity.
If your wishes change after you wrote additional instructions or limitations, the form says to complete a new Health Care Power of Attorney and tell your agent about the changes. Signing a new valid one revokes any prior Health Care Power of Attorney you signed, and the form states this revocation in its first paragraph. You can revoke the document at any time and in any manner; if your attending physician knows about it, the revocation is effective only when it is communicated to that physician.
Documents you need
- Two eligible adult witnesses who sign the witness block, if you do not use a notary; they must be present when you sign or acknowledge your signature and must not be related to you or be the agent.
- A completed notary acknowledgment (county, date, principal's name, notary signature and commission expiration), if you do not use two witnesses.
- Additional pages, only if the space under Additional Instructions or Limitations is not enough for what you want to write.
How to fill out Power Of Attorney For Health Care – Ohio
Print your name and birth date
At the top, under Health Care Power of Attorney of, print your full name and enter your birth date.
Name your agent
Under Naming of My Agent, enter the agent's name, current address and current telephone number. The agent must be an adult who is eligible under Ohio law.
Name alternate agents if you wish
Under Naming of Alternate Agents, enter the name, address and telephone number for a First and a Second Alternate Agent, in order of priority. You may name only one or none; the form suggests crossing out unused lines.
Review the agent's authority
Read the seven-plus items under Authority of Agent, numbered 1 through 11. Cross out any authority you do not want your agent to have.
Decide on the special instruction
Under Special Instructions, place your initials on the line at number 3 only if you want your agent to refuse or withdraw artificially or technologically supplied nutrition or hydration in the situation described in numbers 1 and 2.
Add instructions or limitations
Under Additional Instructions or Limitations, write any specific instructions or limits, or write "None" or cross out the unused lines. Attach extra pages if the space is not enough.
Answer the Living Will and donation statements
Mark Yes or No for whether you completed a Living Will, whether you made your wishes about organ and tissue donation known in your Living Will, and whether you completed the Donor Registry Enrollment Form.
Sign and date as principal
In the Signature section, enter the date, year and place in Ohio, then sign as principal. Sign only when your witnesses or the notary are present.
Complete the witnesses or the notary block
Choose one. Two eligible witnesses each sign, print their name, enter their residence and date; or a notary public completes the Notary Acknowledgment with county, date, your name, signature and commission expiration.
Review and download the completed PDF
Check that every section is filled or crossed out as intended and that the witnesses are eligible. Download or print the completed PDF from FillingPDF, and share copies as described under How to submit.
How to submit Power Of Attorney For Health Care – Ohio
The form does not name an agency to send it to. After it is signed and either witnessed or notarized, you keep the original, tell people about it, and may file a copy with the county recorder.
- Keep and share it: The form says you are responsible for telling members of your family and your physician about the document and the name of your agent. You may also tell your religious advisor and your lawyer, and give each person a copy. Any person may rely on a copy of the document.
- County recorder: The form says you may choose to file a copy with your county recorder for safekeeping. The Summit County Fiscal Office's forms page notes that the document cannot be recorded unless it is signed by two eligible witnesses or acknowledged before a notary public.
- Questions about the form: The Summit County Fiscal Office publishes it at https://fiscaloffice.summitoh.net/forms.
FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Signing without either two eligible witnesses or a notary public acknowledgment; the form is not valid without one of them.
- Using a witness who is the agent, a successor agent, your spouse, your child, another relative by blood, marriage or adoption, your attending physician, or a nursing home administrator.
- Naming your attending physician or the administrator of your nursing home as agent, which the Ohio notice says you cannot do.
- Leaving authority in the list that you do not want your agent to have instead of crossing it out, as the form's note directs.
- Not placing your initials on the Special Instructions line when you want your agent to be able to refuse or withdraw tube nutrition or hydration if you are permanently unconscious.
- Changing your wishes without completing a new Health Care Power of Attorney after you wrote additional instructions or limitations.
- Not telling your family and your physician about the document and the name of your agent, which the form says is your responsibility.
- Treating the witness block and the notary acknowledgment as both required; the form says to choose one.
Frequently asked questions
What is a Power of Attorney for Health Care in Ohio?
It is a document in which an adult, the principal, names an agent to make health care decisions if the principal cannot. This Summit County Fiscal Office form is titled Health Care Power of Attorney and takes effect only when you cannot make your own health care decisions.
Who can I name as my health care agent?
Generally any competent adult. You cannot name your attending physician or a nursing home administrator where you receive care. You also cannot name an employee or agent of your physician or treating facility, unless that person is a competent adult related to you or in the same religious order.
Do I need witnesses or a notary to sign it?
You need one or the other. The form is valid if it is signed by two eligible adult witnesses present when you sign or acknowledge your signature, or if it is acknowledged before a notary public. Witnesses cannot be relatives, the agent, your attending physician or a nursing home administrator.
Does a health care power of attorney expire?
No, the form states it has no expiration date and is not affected by your disability or the passage of time. The Ohio notice says you may choose to specify a date, but if you lack capacity on that date, the document stays in effect until you regain capacity.
How do I revoke my Health Care Power of Attorney?
You may revoke the agent's designation or the whole document at any time and in any manner. If your attending physician is aware of the document, the revocation takes effect only when communicated to that physician. Signing a new valid one also revokes a prior one.
Where do I file the signed form?
The form names no agency to send it to. You keep the signed original, tell your family and physician about it and your agent's name, and may file a copy with your county recorder for safekeeping. Any person may rely on a copy of the document.
Can I fill out the Power Of Attorney For Health Care online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service, is not affiliated with the Summit County Fiscal Office and does not file the form; you still need witnesses or a notary and keep the signed original.
What is the difference between this form and a Living Will?
This form names an agent to make health care decisions for you. A Living Will is a separate document that states the health care you want if you become terminally ill or permanently unconscious. The form asks you to mark whether you have completed a Living Will.
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