Ohio Living Will Declaration Form

The Ohio Living Will Declaration provides the principal with the means to choose what type of medical treatment they receive in the event of a principal being unable to convey their wishes to the health care professionals. This document is created with respect to US statutes §§2133.01 to 2133.15, it is a formal declaration which is legally binding in the state of Ohio and to be legally binding it requires a notary or two witnesses. It will be invalid if the principal becomes pregnant. Patients may enter details of their own preferences regarding their health care should the criteria of the document not suit their specific needs.

How to Write

Living Will Declaration

The principal must enter their personal details.

  • Name.
  • Date of birth.


Special Instructions

The principal must initial part 3 if they wish to agree to the conditions regarding withholding or withdrawing artificial hydration and nutrition.



The details of two people to be notified in the event of the primary physician deciding to withhold or withdrawing life sustaining treatment.

  • Name.
  • Address.
  • Telephone numbers.


Anatomical Gift (Optional)

The principal must denote their wishes regarding an anatomical donation.

  • Initial to make an anatomical donation.
  • Initial to not make an anatomical donation.
  • Enter principal`s name and also enter details of any specific conditions regarding an anatomical donation.
  • Initial `Yes` or `No` to state whether or not the principal has completed a donor registry enrollment form.


Health Care Power Of Attorney

The principal must state whether or not they have completed a Health Care Power Of Attorney.



The principal must enter their details to acknowledge the living will document.

  • Date.
  • Location.
  • Signature of principal.

Witnesses And Notary

The details of the witnesses and the notary must be entered.

  • Witnesses signature.
  • Witnesses address.
  • Witnesses name.
  • Date.
  • County.
  • Date.
  • Principal`s name.
  • Notary`s name.
  • Date of expiration of commission.