Ohio Healthcare Documents Trio (3 Templates)

Ohio Healthcare Documents Trio (3 Templates)

Three Ohio health care documents that work together: a Health Care Power of Attorney with the notice Ohio requires, a Living Will Declaration, and a HIPAA authorization.

What's included

• Health Care Power of Attorney (11 pages): names a health care attorney in fact and alternates under Ohio Rev. Code 1337.11 to 1337.17, opens with the Notice to Adult Executing This Document required by section 1337.17 (reproduced verbatim, with its required capitals), and includes the capitalized nutrition and hydration statement with an initial line, immediate access to health information, and an optional guardian nomination.
• Living Will Declaration (7 pages): a declaration about life-sustaining treatment in a terminal condition or a permanently unconscious state, using the terms and definitions of Ohio Rev. Code 2133.01 as section 2133.02 requires, with the capitalized nutrition and hydration statement, persons to be notified, and the detachable donor registry enrollment form that section 2133.07(C) requires in printed declaration forms.
• HIPAA Authorization / Release (10 pages): lets the people named receive protected health information from doctors, hospitals and health plans. Built on the federal core elements (45 C.F.R. §164.508), with an optional written release of HIV test results naming recipients and a time period (Ohio Rev. Code 3701.243), an optional consent for mental health hospitalization records (Ohio Rev. Code 5122.31), an optional psychotherapy-notes exhibit, and a revocation form.

Each document starts on its own page with plain-English completion notes, followed by the blank form. Where Ohio law supplies a form or required notice, the statutory wording is reproduced verbatim.

Signing requirements (Ohio)

• Health Care Power of Attorney: signed at the end and dated, then either two adult witnesses or a notary acknowledgment. Relatives by blood, marriage or adoption, the attorney in fact and alternates, the attending physician, and a nursing home administrator may not witness (Ohio Rev. Code 1337.12).
• Living Will Declaration: signed at the end and dated, then either two adult witnesses (not related by blood, marriage or adoption, not the attending physician, not a nursing home administrator) or a notary acknowledgment (Ohio Rev. Code 2133.02).
• HIPAA Authorization / Release: signature and date only; no witnesses or notary are required. The optional HIV release and mental health records consent are signed separately.

File formats

Editable Word (.docx) and print-ready PDF (US Letter) for every document, delivered as a ZIP digital download. Nothing is shipped.

Legal research last verified September 29, 2026.

This is a fill-in template, not legal advice. Laws change; check your state's current requirements before signing.

Licensed to the original purchaser for personal use only; not for resale or redistribution.

Some content in this template was drafted with the help of AI tools and reviewed before listing.