Ohio Living Will Form

The Ohio living will is a legal document that provides a written record of one’s (Principal) wishes with regard to medical choices when the Principal is no longer able to make their own medical decisions. Once completed, the medical providers as well as the health care agent (if one has been appointed) may refer to this document to ensure that the Principal’s wishes are being honored. The Principal must be certain to have the document either witnessed or witnessed by a notary public to be legally effective. This document must be completed in advance and while the Principal is of sound mind. The document may be changed or even revoked as the Principal deems necessary.


Laws – 2133.01, et seq. Modified Uniform Rights of the Terminally Ill Act

How to Write

Step 1 – The Principal must download the form and begin by reading the “Notice” on page one (1)

Step 2 – Begin, on page two (2), establish the document by entering:

  • The testator’s name
  • Testator’s date of birth

Step 3 – Testator must read the information and definitions provided, before proceeding:

  • Read all information regarding health care in the case of a terminal condition or an unconscious state

Step 4 – Special Instructions –

  • Carefully review all information in this section
  • Once reviewed, the Principal must initial line 3
  • Read “Notifications”

Step 5 – Contacts – If the Principal would like specific persons to be contacted enter the following:

  • Contact’s names
  • Complete address
  • Telephone number

Step 6 – Anatomical Gifts – Should the Principal elect to make an anatomical gift, the Principal must complete the “Donor Registry Enrollment Form” provided:

  • If the Principal chooses not to participate in this program, simply leave the section blank
  • The Principal must initial the selected option
  • Enter the Principal’s name
  • Specify any specific parts to be donated or “any”
  • Check “yes” or “no” as to whether or not the Principal has completed the form
  • If so…
  • Enter the date of completion in mm/dd/yyyy format
  • Enter the city in which the document is implemented
  • Principal’s signature
  • Read the ending instructions

Step 7 – Signatures – Principal must select witnesses OR Notary acknowledgement – Witnesses must read and understand the witness statement before application of signature

Witnesses – Submit the following:

  • Witnesses signatures (respective)
  • Printed names
  • Complete addresses
  • Date of signatures

Notary Public – If the Principal chooses notary acknowledgement, the Principal must only provide signature before a notary.

  • The notary will acknowledge the document by completing the acknowledgement section at the end of the form
  • The notary shall affix their official stamp or seal

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