This Health Care Power of Attorney will have no expiration date and No Expiration Date. will not be affected by my disability or by the passage of time. I intend that the authority given to my agent will eliminate the need for any Guardian. court to appoint a guardian of my person. However, should such proceedings start, I nominate my agent to serve as the guardian of my person, without bond. My agent may take for me, at my expense, any action my agent Enforcement by Agent. considers advisable to enforce my wishes under this document. My agent will not incur any personal liability to me Release of Agent’s Personal Liability. or my estate for making reasonable choices in good faith concerning my health care. Any person may rely on a copy of this document. Copies the Same as Original. I intend that this document be honored in any jurisdiction to Out of State Application. the extent allowed by law. I have completed a Living Will: Yes No Living Will. I have made my wishes regarding organ and tissue donation in Anatomical Gift(s). my Living Will: Yes No I have completed the Donor Registry Enrollment Form: Donor Registry Enrollment Form. Yes No SIGNATURE [See next page for witness or notary requirements.] I understand the purpose and effect of this document and sign my name to this Health Care Power of Attorney on , 20 , at , Ohio. PRINCIPAL [You are responsible for telling members of your family and your physician about this document and the name of your agent. You also may wish, but are not required to tell your religious advisor and your lawyer that you have signed a Health Care Power of Attorney. You may wish to give a copy to each person notified.] [You may choose to file a copy of this Health Care Power of Attorney with your county recorder for safekeeping.]
No Expiration Date. This Health Care Power of Attorney will have no expiration date and will not be affected by my disability or by the passage of time. Guardian. I intend that the authority given to my agent will eliminate the need for any court to appoint a guardian of my person. However, should such proceedings start, I nominate my agent to serve as the guardian of my person, without bond. Enforcement by Agent. My agent may take for me, at my expense, any action my agent considers advisable to enforce my wishes under this document. Release of Agent’s Personal Liability. My agent will not incur any personal liability to me or my estate for making reasonable choices in good faith concerning my health care. Copies the Same as Original. Any person may rely on a copy of this document. Out of State Application. I intend that this document be honored in any jurisdiction to the extent allowed by law. Living Will. I have completed a Living Will: Yes No Anatomical Gift(s). I have made my wishes regarding organ and tissue donation in my Living Will: Yes No Donor Registry Enrollment Form. I have completed the Donor Registry Enrollment Form: Yes No SIGNATURE [See next page for witness or notary requirements.] I understand the purpose and effect of this document and sign my name to this Health Care Power of Attorney on , 20 , at , Ohio. PRINCIPAL [You are responsible for telling members of your family and your physician about this document and the name of your agent. You also may wish, but are not required to tell your religious advisor and your lawyer that you have signed a Health Care Power of Attorney. You may wish to give a copy to each person notified.] [You may choose to file a copy of this Health Care Power of Attorney with your county recorder for safekeeping.]
ohio-durable-power-of-attorney-health-care.docx