Patient Education Advance Directives State of Ohio Forms

State
 of
 Ohio
 Advance
 Directives:

Health
 Care
 Power
 of
 Attorney

Living
 Will
 Declaration

I
 have
 completed
 a
  Health
 Care
 Power
 of
 Attorney:

Yes
 _____No_______.

I
 have
 added
 special
 notes
 to
 my
 Health
 Care
 Power
 of
 Attorney:

 Yes_____
 No_______.

I
 have
 included
  Nomination
 of
 Guardian(s)
  on
 my
 Health
 Care
 Power
 of
 Attorney:

Yes
 _____No
 _______.

I
 have
 completed
 a
  Living
 Will
 Declaration:

Yes_____
 No________.

I
 have
 added
 special
 instructions
 to
 my
 Living
 Will
 Declaration:

  Yes
 _____
 No
 _______.

[NOTE:

 Whenever
 you
 sign
 a
 new
 advance
 directive
 document,
 it
 automatically
 will
 revoke
 prior
 similar

documents
 unless
 you
 provide
 otherwise.

  [R.C.
 §1337.14
 and
 R.C.
 §2133.04
 (C)]

[NOTE:

 If
 you
 make
 changes
 to
 an
 advance
 directive,
 remember
 to
 make
 similar
 changes
 to
 your
 other

advance
 directives.]

 ©
 March
 2015
 Ohio
 State
 Bar
 Association