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State of Ohio Health Care Power of Attorney of

State of OhioHealth care Power of Attorneyof_____(Print Full Name)_____(Birth Date)I State that this is my Health care Power of Attorney and I revoke any prior Health CarePower of Attorney signed by me. I understand the nature and purpose of this any provision is found to be invalid or unenforceable, it will not affect the rest ofthis Health care Power of Attorney is in effect only when I cannot make Health caredecisions for myself. However, this does not require or imply that a court must declareme Several legal and medical terms are used in this document. For conveniencethey are explained or Attorney -in-fact means the adult I name in this Health care Power ofAttorney to make Health care decisions for gift means a donation of all or part of a human body to take effect upon orafter or technologically supplied nutrition or hydration means the providingof food and fluids through intravenous or tube feedings.

State of Ohio Health Care Power of Attorney of _____ (Print Full Name) _____ (Birth Date) I state that this is my Health Care Power of Attorney and I revoke any prior Health Care Power of Attorney signed by me. I understand the nature and purpose of this document. If any provision is found to be invalid or unenforceable, it will not affect the ...

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