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Advance Directive Forms

Advance Directive Forms

You may be able to get Advance Directive and Healthcare Representative Appointment forms from your healthcare provider.

You can use the forms below, which are copied from Senate Bill 199 (2021). You do not have to use these specific forms, but any form you use must be substantially the same.

English .docx  .pdf 
Spanish .docx  .pdf
Arabic .docx  .pdf
Chinese Simplified

.docx  .pdf

Chinese Traditional

.docx  .pdf

Chuukese .docx  .pdf
Hmong .docx  .pdf

.docx  .pdf


.docx  .pdf

Portuguese .docx  .pdf

.docx  .pdf


.docx  pdf

Vietnamese.docx  .pdf

Form for Appointment of Health Care Representative and Alternate

You can also order Advance Directive forms for a fee on the Oregon Health Decisions website.

Everyone has a right to know about and use Oregon Health Authority (OHA) programs and services. OHA provides free help. Some examples of the free help OHA can provide are:

  • Sign language and spoken language interpreters
  • Written materials in other languages
  • Braille
  • Large print
  • Audio and other formats

If you need help or have questions, please contact or 711 TTY.

  Return to Advance Directive Adoption Committee page

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