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Ohio Living Will Declaration

This document is a Living Will Declaration made in accordance with Ohio Revised Code §§ 2133.01 to 2133.24. This declaration outlines your wishes regarding medical treatment in situations where you are no longer able to communicate your preferences.

Personal Information:

  • Name: ___________________________
  • Date of Birth: ____________________
  • Address: _________________________
  • City, State, Zip: ________________

Statement of Intent:

I, the undersigned, declare this to be my Living Will. I wish to express my preferences for medical treatment if I become terminally ill or permanently unconscious and unable to communicate my wishes.

Preferences Regarding Medical Treatment:

  1. If I am in a terminal condition, I do not wish to receive treatment that will only prolong the dying process.
  2. If I am in a persistent vegetative state, I do not wish to receive life-sustaining treatment, except for comfort measures.
  3. Additionally, I would like to provide the following specific instructions: ___________________________.

Appointment of Health Care Agent:

I designate the following person as my health care agent, who is authorized to make decisions on my behalf regarding medical treatment:

  • Name: ___________________________
  • Relationship: ____________________
  • Phone Number: ___________________

Signature:

By signing below, I confirm that I understand the contents of this Living Will Declaration and that it accurately represents my wishes.

Signature: ___________________________

Date: _________________________________

Witnesses:

Two witnesses must sign below. They must be at least 18 years old and cannot be your health care provider or your health care agent.

  • Witness 1 Name: ___________________________
  • Signature: _________________________________
  • Date: ____________________________________
  • Witness 2 Name: ___________________________
  • Signature: _________________________________
  • Date: ____________________________________

This Living Will takes effect only when I am unable to communicate my wishes regarding medical treatment. I understand that I can revoke or change this document at any time while I am of sound mind.

Common mistakes

Filling out a Living Will form in Ohio can be a straightforward process, but many people make common mistakes that can lead to confusion or even legal issues later on. One frequent error is not clearly specifying the medical treatments one wishes to receive or decline. It's important to be explicit about your preferences to ensure that your wishes are followed.

Another mistake is failing to sign and date the form. Without a signature, the document may not be considered valid. Additionally, forgetting to have witnesses present during the signing can also invalidate the Living Will. Ohio law requires that two witnesses are present when you sign the document, so this step should not be overlooked.

Many individuals also neglect to discuss their wishes with family members or healthcare providers. Open conversations can help clarify your intentions and ensure that everyone understands your choices. This can prevent misunderstandings and conflicts in the future.

Some people may fill out the form in a way that is too vague. Phrases like "do everything possible" can lead to uncertainty about what treatments are desired. Instead, be specific about the types of interventions you want or do not want.

Another common oversight is not reviewing the document periodically. Life circumstances and personal beliefs can change over time. It’s important to revisit your Living Will to ensure it still reflects your current wishes.

Additionally, many forget to provide copies of the Living Will to their healthcare providers and family members. Having multiple copies ensures that those who need to make decisions on your behalf have access to your preferences.

Some individuals may also mistakenly assume that a Living Will is the same as a Power of Attorney for healthcare. While both documents are important, they serve different purposes. A Living Will outlines your wishes regarding medical treatment, while a Power of Attorney designates someone to make decisions on your behalf.

Another error is using outdated forms. Laws can change, and it’s essential to use the most current version of the Living Will form to ensure compliance with Ohio regulations.

Finally, people sometimes forget to include specific end-of-life scenarios. It’s beneficial to think about various situations, such as terminal illness or irreversible coma, and express your wishes clearly for each scenario.

By avoiding these common mistakes, individuals can create a Living Will that accurately reflects their wishes and provides peace of mind for themselves and their loved ones.

Dos and Don'ts

When filling out the Ohio Living Will form, consider the following do's and don'ts:

  • Do read the entire form carefully before starting.
  • Do provide clear and specific instructions about your healthcare preferences.
  • Do discuss your wishes with family members and healthcare providers.
  • Do sign and date the form in the presence of a witness or notary, as required.
  • Do keep a copy of the completed form for your records.
  • Don't leave any sections blank unless instructed to do so.
  • Don't use vague language that could lead to confusion about your wishes.
  • Don't forget to update the form if your preferences change.
  • Don't assume that verbal instructions are enough; written documentation is essential.
  • Don't ignore the requirements for witnesses or notarization; they are important for validity.

Similar forms

  • Advance Directive: Similar to a Living Will, an Advance Directive outlines an individual's preferences for medical treatment in situations where they cannot communicate their wishes. It often includes instructions for end-of-life care.
  • Durable Power of Attorney for Health Care: This document allows an individual to designate someone else to make medical decisions on their behalf if they become incapacitated. It complements a Living Will by providing a person to interpret and apply the wishes expressed.
  • Do Not Resuscitate (DNR) Order: A DNR order specifically instructs medical personnel not to perform CPR if a person's heart stops or they stop breathing. It is a more focused directive compared to a Living Will.
  • Health Care Proxy: A Health Care Proxy appoints an individual to make healthcare decisions for someone who is unable to do so. This is similar to a Durable Power of Attorney but specifically for health care matters.
  • Physician Orders for Life-Sustaining Treatment (POLST): This document translates a patient’s wishes regarding life-sustaining treatment into actionable medical orders. It is similar to a Living Will but is designed for individuals with serious health conditions.
  • Do Not Intubate (DNI) Order: A DNI order indicates that a patient does not wish to be intubated if they are unable to breathe on their own. This is a specific directive that can complement a Living Will.
  • Organ Donation Consent Form: This document expresses an individual’s wishes regarding organ donation after death. While it serves a different purpose, it aligns with the overall theme of end-of-life decisions.
  • Florida Durable Power of Attorney: This document allows a principal to designate an agent for managing financial matters, maintaining authority even during incapacity. For more information, visit TopTemplates.info.
  • Emergency Medical Services (EMS) Directive: This directive provides instructions for emergency medical personnel regarding the desired level of care during an emergency. It is similar to a Living Will in that it guides medical treatment preferences.