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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 Advance Directive forms below, which are copied from the 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 
User guide
Spanish
.docx  .pdf User guide
Arabic
.docx  .pdf
User guide
Chinese Simplified
.docx  .pdf User guide
Chinese Traditional .docx  .pdf User guide
Chuukese .docx  .pdf
User guide
Hmong
.docx  .pdf
User guide
Japanese
.docx  .pdf
User guide
Korean
.docx  .pdf User guide
Marshellese .docx  .pdf
User guide
Portuguese .docx  .pdf User guide
Russian .docx  .pdf User guide
Somali .docx  pdf User guide
Vietnamese .docx  .pdf User guide

Form for Appointment of Health Care Representative and Alternate

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 publichealth.policy@dhsoha.state.or.us or 711 TTY.

  Return to Advance Directive Adoption Committee page