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.
The Advance Directive User's Guide, listed below, is to help you complete the Advance Directive form and answers questions you may have about it.
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@odhsoha.oregon.gov or 711 TTY.
Return to Advance Directive Advisory Committee page