§ 2108.10 Forms

§ 2108.10 Forms.

Text of Statute

(A) The document of gift provided for in division (B) of section 2108.04 of the Revised Code shall conform substantially to the following form:

"ANATOMICAL GIFT OF ...................................... Print or type name of living donor

In the hope that I may help others upon my death, I hereby give .......................... the following body parts: ........................ ............................................................................. for any purpose authorized by law: transplantation, therapy, research, or education.

Signed by the donor and the following two witnesses in the presence of each other:

........................................................................................................................................... Signature of Donor ........................................................................................................................................... Date of Birth of Donor ........................................................................................................................................... Date Signed ........................................................................................................................................... Witness ........................................................................................................................................... Witness

This is a legal document under the Uniform Anatomical Gift Act or similar laws."

(B) The document of gift provided for in division (E) of section 2108.04 of the Revised Code shall conform substantially to the following form:

"ANATOMICAL GIFT BY A RELATIVE OR THE GUARDIAN OF THE PERSON OF A DECEDENT

I hereby make this anatomical gift from the body of .......................... who died on

(name) .................................. in ........................................................... (date) (city and state)

The marks in the appropriate squares and the words filled into the blanks below indicate my relationship to the decedent and my desires respecting the anatomical gift.

1. I survive the decedent as:

1. [] spouse;

2. [] adult son or daughter;

3. [] parent;

4. [] adult brother or sister;

5. [] grandparent;

6. [] guardian of the person;

7. [] person authorized to dispose of the body

2. I hereby give the following body parts:

[] Heart [] Liver [] Skin [] Middle Ear

[] Kidneys [] Lung [] Heart Valves [] Other

[] Pancreas [] Eyes [] Bone/Ligament

For: [] Any purpose authorized by law

[] Transplantation

[] Therapy

[] Medical research and education

3. After the donated organs, tissues, or eyes are removed, the remains of the body shall be disposed of in the following manner:

........................................; at the expense of the following

person: ............................................ Date .................. City and State .................................................................................... ............................................................ .................................................................. Witness Signature of Survivor ............................................................ .................................................................. Witness Address of Survivor"

(C) The statement of gift provided for in division (C) of section 2108.04 of the Revised Code shall conform substantially to the following form:

"I hereby make an anatomical gift, to be effective upon my death, of:

(A) [] Any needed body parts

(B) [] The following body part(s): (list) ............................................................................................................................................... Date ....................................................................................................................................... Signature of donor .................................................................................................................. Witness .................................................................................................................................. Witness .................................................................................................................................."

HISTORY: 133 v H 852 (Eff 8-27-70); 137 v S 294 (Eff 6-2-78); 139 v H 54 (Eff 7-23-81); 143 v H 21. Eff 3-27-91.