The Oregon medical power of attorney gives a person the choice of naming an agent that will act on the person's behalf when it comes to medical decisions. In particular, the form provides treatment options for a patient who can no longer communicate. The medical power of attorney is often paired with a living will so the principal can express their healthcare preferences.
Signature Requirements (ORS 127.515(2)(b)) - A notary public or two witnesses are required.
1. The appointment of a health care representative;
2. Instructions for the representative of the health care provider.
3. "Advance directive" includes any document or writing that is attached to the document described in paragraph (a) of this subsection by the principal.
You can download the PDF and WORD versions of the medical power of attorney on this page.
You can also use the power of attorney creator to make a custom power of attorney that better fits the needs of your situation. It can also be accessed on this page.
Name of the Oregon principal. You must have your full name listed as the Oregon Patient issuing medical instructions to the physician.
Oregon Principal's date of birth.
Principal address in Oregon.
Acknowledgment of page. Upon completion of the first page, please provide your full name as evidence that you have read this document and wish to sign it.
Email address of Oregon Principal.
The name and role of your healthcare agent. To appoint a health care agent to represent you in cases of medical need despite communication difficulties, a specific party must be designated. Determine who is best qualified to handle this role, then list his or her name and how you are connected to this person.
Oregon healthcare agent's phone numbers
Contact email address for Oregon healthcare representative.
Name and relationship of a second healthcare representative. Sadly, your healthcare representative may not be able to fulfill this role. For example, they might be out of the country, ill, or otherwise unable to represent you. In setting up an alternate healthcare representative, authority can automatically be transferred from your original representative to the alternate. Identify the full name of the alternative Oregon healthcare representative, along with his or her relationship to you.
Alternate representative’s telephone numbers.
Address of alternate Oregon healthcare representative.
Second alternate representative's name and relationship. When both healthcare agents listed above decline to represent you, are unavailable or revoked, having a second substitute agent in place will ensure that medical decisions on your behalf can be relayed to your doctors.
Email address of the second alternate representative.
Page 2 Acknowledgement. Ensure that your name is always displayed at the bottom of the second page.
Directions for full treatment. In the unlikely event, you don't have more than six months left from a critical illness or disease without a cure, then your doctors will consult this document regarding your treatment options upon becoming unconscious or with a loss of speech. Please initial the first statement in this section if you authorize life-supporting treatments and/or nutritional or hydration insertions.
Guidelines requiring only artificial food and liquids. Treatment directives can be created to exclude life-sustaining treatment or devices while ensuring your fluid and nutrient levels remain unchanged even if you need a tube or an intravenous nutrient solution. To create this, enter the initials of the second declaration.
Request for comfort care. The third declaration allows you to refuse the administration of any life-sustaining treatments, including asking for your natural death. When you tick this clause, Oregon medical professionals will have the authority to disconnect you from any life-sustaining devices and prevent any further life-sustaining interventions. If you change your mind, the instructions you give verbally will be followed.
Make this decision with your health care agent. It is your choice on how Oregon physicians handle your terminal illness with a six-month survival rate, or your Oregon healthcare agent can choose for you if you are incapable of communicating. Assign this decision-making authority to your current Oregon healthcare agent by completing declaration number four.
Date and signature. Examine the information, documents, and attachments you would like the doctors to use as your healthcare guidelines. For this document to become active, sign it in front of a notary public or two adult witnesses.
Sign your document and have it notarized. Upon signing this document before a Notary Public, she or he will attest that you have signed it legally by notarizing your signature.
Names and signatures of witnesses. Printed and signed witness statements prove that the witness statements are accurate.
Date the witnesses' signatures. In addition to names and signatures, each witness must indicate the date.
Name and signature of the health representatives. Each person who will have access to your medical treatment directives must acknowledge their acceptance in a written statement. After reading this statement, the Oregon healthcare agent should print his or her full name, sign it legally, and record the date they were created.
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