Fill and Sign the Receipt and Release Personal Representative of the Form

DURABLE POWER OF ATTORNEY FOR HEALTH CARE (Ohio Revised Code 1337.11 to 1337.17) The following Notice to Adult Executing This Document (Durable Power of Attorney for Health Care) is required by Ohio Revised Code, Section 1337.17. If, after reading this notice, you still have questions concerning the effect and legal consequences of executing this document, you should speak with a qualified attorney. NOTICE TO ADULT EXECUTING THIS DOCUMENT This is an important legal document. Before executing this document, you should know these facts: This document gives the person you designate (the attorney in fact) the power to make MOST health care decisions for you if you lose the capacity to make informed health care decisions for yourself. This power is effective only when your attending physician determines that you have lost the capacity to make informed health care decisions for yourself and, notwithstanding this document, as long as you have the capacity to make informed health care decisions for yourself, you retain the right to make all medical and other health care decisions for yourself. You may include specific limitations in this document on the authority of the attorney in fact to make health care decisions for you. Subject to any specific limitations you include in this document, if your attending physician determines that you have lost the capacity to make an informed decision on a health care matter, the attorney in fact GENERALLY will be authorized by this document to make health care decisions for you to the same extent as you could make those decisions yourself, if you had the capacity to do so. The authority of the attorney in fact to make health care decisions for you GENERALLY will include the authority to give informed consent, to refuse to give informed consent, or to withdraw informed consent to any care, treatment, service, or procedure to maintain, diagnose, or treat a physical or mental condition.
This document does not relieve you, as a person with a physical disability, of the responsibility and expenses of taking care of yourself. You should consult with a qualified physician about the best approach to personal finances when you become a legally incompetent adult. You must understand the legal consequences of your failing and remain aware and sensitive to these consequences. When you fail or refuse to take care of yourself adequately, you may be required to pay any costs and expenses your attending physician does not incur or that your attending physician reasonably determines you will not incur during your life as a result of your failing and the failure by you to take care of yourself. The attorney in fact is not liable to you for any damages caused by your failing or refusal to take care of yourself adequately or by actions or inaction of the attorney in fact. You remain personally responsible for all activities you undertake to take care of yourself. You may not delegate your legal responsibility or responsibilities to your attorney in fact until the expiration and revocation of the power of attorney for health care that you have executed hereunder. If you continue to own a motor vehicle when you are legally incompetent, you must obtain insurance to pay for your medical expenses. To access this insurance, complete the application listed in the appendix of this guide. To avoid any financial harm to you, your health care and living expenses have been excluded from this policy. You must sign the application and accept the terms and conditions in its entirety (unless you have a religious objection to the application or the terms of the policy). Your motor vehicle insurance is therefore not a valid insurance policy for medical purposes. Do not attempt to obtain an insurance policy without first taking action to execute a durable power of attorney as provided in this document. The contents of this guide are not intended to provide legal advice. Consult a competent attorney as to legal issues concerning you. This document is not intended to be comprehensive. Specific questions concerning insurance benefits, medical expenses, treatment requirements of the attending physician, and other financial considerations should be discussed with an appropriate medical provider. Do not hesitate to contact the Ohio department of insurance's office of consumer services at. Note: to assist you with any additional legal questions and your decision to proceed, please review the Ohio revised code to determine your legal responsibilities and obligations.<|endowment|>sitting at the foot of the mountain and surrounded by thousands of stars, on the night of June 4, 1969, i knew i was on to something. By morning I had found what i was looking for: a way to keep.