Is an electronic signature legally valid?

Yes—under the federal ESIGN Act (15 U.S.C. ch. 96) and state UETA statutes, electronic signatures are legally equivalent to handwritten signatures for most transactions, provided intent, consent, attribution, and record retention requirements are met.

Who can be named as my agent?

Any adult competent to act can be an agent unless disqualified by local statute; avoid naming someone with conflicts of interest and provide successor agents in writing to prevent gaps.

Do I need witnesses or a notary?

It depends on state law. Some states require notarization, some require one or two witnesses, and a few require both. Confirm the rule where you sign to ensure enforceability.

Can I sign the declaration electronically?

Often yes. Electronic execution is permitted in most jurisdictions when the platform captures intent, authentication, and an audit trail. Certain notarial or witness steps may require in-person or RON-compliant notarization.

How do I revoke or change the document?

Revoke by signing a revocation statement, destroying originals, and notifying your agent and medical providers. For changes, execute a new document and distribute the updated version.

What happens if the agent cannot act?

If your primary agent is unavailable or unwilling, a named successor steps in. If no successor exists, courts or providers may appoint a guardian or seek directions through a legal proceeding.

Electronic Signature
Templates
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Declaration Relating to Life Sustaining and Durable Power of Attorney

Declaration Relating to Life Sustaining and Durable Power of Attorney

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

REVOCATION OF DECLARATION CONCERNING
THE USE OF LIFE SUSTAINING TREATMENT

I, , Declarant,

executed a Declaration Concerning the Use of Life Sustaining Treatment on the day of , 20 regarding my decisions and choice that my life not be prolonged by extraordinary means or by artificial nutrition or hydration if my condition were to be determined to be terminal or if I were diagnosed as being in a permanent unconscious state.

Ohio Revised Code § 2133.04 provides that I may revoke my Declaration at any time and in any manner.

This is my written revocation of my Declaration Concerning the Use of Life Sustaining Treatment and is provided to all persons to whom I have provided a copy of my Declaration.

DATED this the day of , 20

Signature of Declarant:

Printed Name of Declarant:

Address of Declarant:

What this declaration and durable power of attorney is

The Declaration Relating to Life Sustaining and Durable Power of Attorney combines two related legal elements: a declaration of your preferences about life-sustaining treatment and a durable power of attorney authorizing a named agent to make health and financial decisions if you become incapacitated. Together these documents state treatment wishes, name decision-makers, and set the conditions under which the agent’s authority takes effect. They are used to ensure medical teams, caregivers, and financial institutions can act according to your directions when you cannot speak for yourself.

Why this document matters for planning and care

This combined declaration clarifies your treatment preferences, prevents uncertainty during medical crises, and designates a trusted agent to manage medical and financial affairs. Clear instructions reduce disputes, streamline hospital decision-making, and protect your interests if you lose capacity.

Who typically completes this declaration

Use this form as part of an advance care planning packet and share copies with your agent, physician, and family.

Adults planning advance care and incapacity contingencies, including older adults and those with chronic conditions.
Family members coordinating care who need a clear, legally valid statement of the principal’s wishes.
Healthcare providers and institutions requiring documented authorization to follow or decline life-sustaining treatments.

Typical signers and their roles

Principal

An adult with capacity who sets treatment preferences and names an agent. The principal must sign voluntarily and understand the document’s effect; inaccurate or incomplete identification can limit enforceability.

Agent / Attorney-in-Fact

A trusted person designated to make health or financial decisions when the principal is incapacitated. The agent should be informed of the principal’s wishes and able to produce proof of authority when interacting with providers or institutions.

Core parts of the Declaration Relating to Life Sustaining and Durable Power of Attorney

The document must clearly identify parties, describe agent powers, state life-sustaining preferences, specify effective dates or triggering events, include signature blocks, and contain revocation language.

Identification

Full legal name, date of birth, and address of the principal to avoid ambiguity when agents present the document to providers or institutions.

Agent Authority

Explicit description of the agent’s powers (medical decisions, financial transactions, access to records) and any limits or required conditions for exercise.

Life-Sustaining Preferences

Clear directives on CPR, mechanical ventilation, artificial nutrition and hydration, and other life-sustaining measures, including any conditional choices or personal values statements.

Effective Trigger

Language stating when the durable POA becomes effective (immediately or upon incapacity) and who determines incapacity, if applicable.

Signatures & Date

Signature of the principal and date, plus signature lines for witnesses and notary as required by jurisdiction to establish validity.

Revocation

A clause describing how to revoke or amend the declaration and POA and instructions to inform the agent and relevant providers.

Step-by-step: completing the declaration and durable POA

Follow these steps in order to create a clear, enforceable declaration and durable power of attorney.

01

Prepare details: Gather full names, DOBs, contact info, and any medical wishes.
02

Draft preferences: Write explicit life-sustaining treatment instructions and exceptions.
03

Name an agent: Select one or more agents and specify succession if needed.
04

Sign with witnesses: Sign in required presence; obtain notary if your state requires it.

Where to send or file copies after signing

After execution, distribute certified copies to the right parties so your wishes can be honored without delay.

Primary care physician: Provide a signed copy for inclusion in the medical record.
Named agent: Give originals or certified copies to your agent for immediate access.
Hospital / treating facility: Deliver a copy during admission or store it with online medical portals.
Family members: Share copies with close relatives to avoid confusion during emergencies.

Customizing and completing the form online

When using an electronic workflow, set up fields and authentication to match legal and institutional requirements.

Field	Configuration
Principal Signature	Signed with witnessed notary field linked
Witness Blocks	Conditional fields appear if the state requires witnesses
Notary Acknowledgment	Include space for stamp, notary signature, and date
Document Access	Set permissions so agent and providers can download copies

Digital signing and technical considerations

Ensure the chosen platform can capture timestamps, signer identity, and produce a tamper-evident audit record for use with medical and financial institutions.

File formats: PDF, DOCX supported
Authentication: Email, SMS, or advanced ID methods
Integrations: EMR and cloud storage compatible

Key risks and legal consequences

Invalid Execution: Document may be unenforceable

Agent Overreach: Unauthorized actions risk civil liability

Medical Noncompliance: Hospitals may delay treatment

Estate Conflicts: Competing documents can trigger litigation

Loss of Records: Missing originals complicate probate

HIPAA Violations: Improper disclosure may trigger penalties

Common mistakes to avoid

Using an unclear agent designation that does not identify successor agents or contact details.
Failing to execute the document before the required number of witnesses and a notary when state law requires both.
Entering ambiguous medical instructions rather than specific preferences for life-sustaining treatment options.
Not distributing copies to the agent, primary care physician, and treating hospital before a crisis occurs.

Practical tips for a valid, usable document

Follow these best practices to improve clarity and enforceability.

Use clear, specific language

State precise choices regarding CPR, ventilation, and artificial nutrition. Vague statements invite interpretation and dispute by clinicians or family members.

Confirm witness and notary rules

Sign in the presence of the exact number of witnesses and notary required by your jurisdiction; some states require two witnesses for durable POAs.

Share certified copies

Provide certified or notarized copies to your agent, physician, and hospital intake staff so care teams can act quickly.

Review periodically

Revisit the document after major life events (marriage, divorce, diagnosis) and update or revoke as necessary.

eSignature pricing and capability snapshot for executing this declaration

Comparing common eSignature vendors can help determine platform suitability for notarization, HIPAA protection, and bulk distribution needs.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Frequently asked questions and quick answers

Answers to common legal and execution questions about the Declaration Relating to Life Sustaining and Durable Power of Attorney.

Need help? Contact support

Is an electronic signature legally valid?
Yes—under the federal ESIGN Act (15 U.S.C. ch. 96) and state UETA statutes, electronic signatures are legally equivalent to handwritten signatures for most transactions, provided intent, consent, attribution, and record retention requirements are met.
Who can be named as my agent?
Any adult competent to act can be an agent unless disqualified by local statute; avoid naming someone with conflicts of interest and provide successor agents in writing to prevent gaps.
Do I need witnesses or a notary?
It depends on state law. Some states require notarization, some require one or two witnesses, and a few require both. Confirm the rule where you sign to ensure enforceability.
Can I sign the declaration electronically?
Often yes. Electronic execution is permitted in most jurisdictions when the platform captures intent, authentication, and an audit trail. Certain notarial or witness steps may require in-person or RON-compliant notarization.
How do I revoke or change the document?
Revoke by signing a revocation statement, destroying originals, and notifying your agent and medical providers. For changes, execute a new document and distribute the updated version.
What happens if the agent cannot act?
If your primary agent is unavailable or unwilling, a named successor steps in. If no successor exists, courts or providers may appoint a guardian or seek directions through a legal proceeding.

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