Ohio Living Will
This Ohio Living Will is created in accordance with Ohio Revised Code § 2133.01 to 2133.29. It serves to outline your preferences regarding medical treatment in the event you are unable to communicate those wishes.
Individual Information:
- Full Name: ___________________________________________
- Date of Birth: ________________________________________
- Address: _____________________________________________
- Phone Number: ________________________________________
You have the right to specify your wishes regarding medical procedures and interventions. Please consider the following preferences:
- In the event that I have a terminal condition or am in a persistent vegetative state, I direct that:
- All life-sustaining treatment be withheld.
- Life-sustaining treatment be provided, including nutrition and hydration.
- If I am unable to make decisions, I appoint the following individual as my healthcare agent:
- Name: ___________________________________________
- Relationship: ______________________________________
- Phone Number: _____________________________________
- I wish to express my desires regarding organ donation:
- I wish to donate my organs/tissues after my death.
- I do not wish to donate my organs/tissues after my death.
Signature:
By signing this document, I affirm that I understand its content and that I am of sound mind to make these decisions.
Signature: __________________________________ Date: _____________
Two witnesses are required for this document to be valid:
- Witness 1: _________________________________________
- Witness 2: _________________________________________