Ohio Living Will Template
This Ohio Living Will is designed to comply with Ohio state laws regarding advanced healthcare directives.
By filling out this document, you express your wishes concerning medical care and treatments in the event that you become unable to communicate your preferences.
Please provide the following information:
- Your Full Name: ________________________________________
- Your Address: ________________________________________
- Your Date of Birth: _________________________________
In accordance with Ohio law, I declare that if I become unable to make my own healthcare decisions, I want my wishes to be known as follows:
I wish to receive the following types of medical treatment:
- _________ (e.g., life-saving treatments)
- _________ (e.g., resuscitation)
- _________ (e.g., mechanical ventilation)
If I am diagnosed with a terminal condition and the prognosis is that I will not recover, I wish to refuse:
- _________ (e.g., artificial nutrition and hydration)
- _________ (e.g., pain-relieving medications)
I also wish to designate the following person as my healthcare agent:
- Agent's Full Name: ________________________________________
- Agent's Address: ________________________________________
- Agent's Phone Number: _________________________________
This document becomes effective when I am unable to make my own healthcare decisions.
Signed this _________ day of ________________, 20___.
Signature: ________________________________