Ohio Advance Directive

Information you will need

• Agent Address
• Alternate Agent Name/Relationship
• Second Alternate Agent Name/Relationship
• Alternate Agent Address
• Alternate Agent Phone Number
• Second Alternate Agent Phone Number
• Second Alternate Agent Address
• Protected Health Care Information
• Special Instructions No Living Will
• Agent Name/Relationship
• Alternate Guardian of Person Address
• Guardian of Person Name/Relationship
• Guardian of Person Address
• Guardian of Person Phone Number
• Alternate Guardian of Person Name/Relationship
• Alternate Guardian of Person Phone Number
• Guardian of Person
• Guardian of Estate Name/Relationship
• Guardian of Estate Address
• Guardian of Estate Phone Number
• Alternate Guardian of Estate Name/Relationship
• Alternate Guardian of Estate Address
• Alternate Guardian of Estate Phone Number
• Guardian of Estate

…and 72 more fields in the PDF.

Completed by the agent and the donor and the principal.

The form includes a notary acknowledgment, a witness section.