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.
Overview of Oregon's New Advance Directive Form (Presentation)

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 Advisory Committee page