Free Oregon Medical Power of Attorney Form

About the Oregon Medical POA

A medical power of attorney is a document in which you, the principal, name an agent to make health care decisions for you if you cannot make them yourself. You may need one after an accident or when an illness becomes serious. You may also hear the agent called a health care proxy. The FormsPal template pairs the appointment with an advance directive, a statement of your end-of-life wishes.

Use the sections below to check the Oregon rules, then complete each part of the form.

Oregon Legal Requirements

Oregon sets rules for how a medical power of attorney is signed and who may witness it. Both come from sections 127.505 and 127.515 of the Oregon Revised Statutes.^[1.1][1.2] The parts below put each rule in plain words, so you can check them before you sign.

Signing and Witness Rules

The principal is the person making the document, and the principal must sign it.^[1.1] The document must also be witnessed and signed by at least two adults, or notarized by a notary public.^[1.2]

• At least two witnesses are required if you do not use a notary public.
• The witnesses may not be your attending physician or attending health care provider.
• The witnesses may not be your health care representative or alternate health care representative, the agent you appoint and your backup.^[1.2]

Oregon Form Details

What Does the Oregon Form Cover?

The FormsPal template is titled Oregon Medical Power of Attorney with Advance Directive. It has three numbered parts and a notary page. What each part says comes from the printed text of the form, not from Oregon law, so read all of it before you sign.

• Part I, Power of Attorney for Health Care. You, the principal, name your agent and an alternate agent here. The printed text lists the powers your agent receives, such as consenting to medical care, hiring health care personnel and getting your medical records.
• Part II, Advance Health Care Directive. This part states your end-of-life wishes. The printed wording asks your providers to withhold or withdraw all treatments other than those needed to keep you comfortable in the situations it lists. It also asks for pain relief.
• Part III, General Provisions. These are standard terms for the whole document. The signature and date lines come right after them.
• Acknowledgment. The last page is a block that a notary public completes.

Part II is a serious statement about end-of-life care, so check that it matches your wishes. If you wish to go a different way or have special concerns, talk to a lawyer or your doctor before you sign.

How to Fill Out the Oregon Form

The form has 21 fillable fields, and the five steps below follow it from page 1 to page 7. Fill it in online with the Create My Document button above, or print the PDF and write your answers by hand. Each step names the part of the form it covers.

The screenshots under each step show the FormsPal Oregon medical power of attorney template filled with sample entries in blue, so you can see where each answer goes. The names, addresses, dates and amounts are examples only.

1. Name the principal and the agent. On page 1, enter your full name and home address as the principal. Next, enter the full name and address of the person you appoint as your agent. You do not choose a start date here, because Part I, Section 2 of the form sets when the agent’s authority takes effect.

   

2. Add contact details and the alternate agent. Still on page 1, fill in the agent’s phone number, email and alternative contact information. Then complete the ALTERNATE AGENT paragraph. Repeat the agent’s name, then add the alternate agent’s name, address, phone number, email and alternative contact information.

   

3. Date and sign. On page 6, write the date, sign on the signature line and print your name beneath it. Sign it in front of your witnesses or the notary public.^[1.2]

   

4. Complete the notary acknowledgment. Page 7 holds the acknowledgment for the State of Oregon. It has fields for the county, the date, the notary’s name and title, and your name.

   

5. Notary signature and seal. The notary signs on the Signature line at the bottom of page 7 and adds the official seal.

   

Signing and Using the Document

Filling in the blanks is only part of the job. The steps below cover what happens around the form, from getting the template to handing out copies. Follow the signing rules from the requirements section above.

1. Get the template. Download the PDF from this page, or answer a few questions in our form builder to create your document online.
2. Read the whole form. Go through Parts I to III and the acknowledgment. Check that Part II matches your wishes.
3. Choose how to sign. Either gather two adult witnesses who may serve, or plan to sign the document before a notary public instead.^[1.2]
4. Sign. The principal must sign the document.^[1.1] Do it in front of your witnesses or the notary public.^[1.2]
5. Keep and share copies. It is common practice to keep the original somewhere safe and give copies to each individual who may need one, such as your agent and your doctor. Review the form every few years and after a major life change. If you are capable, you may revoke your advance directive at any time and in any manner.^[1.3] Some people compare it with an Oregon living will form, which is a separate document.

The FormsPal template has a notary block but no lines for witnesses. If you plan to use witnesses, ask a lawyer how to record their signatures before you sign. This page covers health care decisions only. Money and property decisions need separate documents, such as a durable power of attorney.

Frequently Asked Questions

These answers cover the signing and witness rules in Oregon. Each one comes from the Oregon statutes listed in the Sources section. For legal questions beyond these basics, talk to a lawyer.

How many witnesses do you need in Oregon?

At least two adults must witness and sign it. The other choice is to have it notarized by a notary public.^[1.2]

Can a notary replace the witnesses?

Yes. Instead of signing before witnesses, the principal may sign the document before a notary public.^[1.2]

Who cannot be a witness?

On the date the document is signed or acknowledged, a witness may not be any of these people:

• the principal’s attending physician or attending health care provider
• the principal’s health care representative or alternate health care representative^[1.2]

Who has to sign the document?

The principal, the person making the document, must sign it.^[1.1]

Other Oregon Forms
Different essential Oregon forms available for download here and that can be modified in our hassle-free document builder.

• Oregon Last Will
• Oregon Small Estate Affidavit
• Oregon Bill of Sale
• Oregon Rental Lease Agreement
• Oregon Eviction Notice

Download a Free Oregon Medical Power of Attorney Form

You can download this medical power of attorney with advance directive as a PDF with 21 fillable fields, or build it online and print it. Either way, you still need to finish it with at least two adult witnesses or a notary public.^[1.2]

Create a free high quality Oregon Medical Power of Attorney online now!

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General information, not legal or tax advice.

Sources

1. Oregon State Legislature. Oregon Revised Statutes sections 127.505 to 127.515.
   • 1.1 Or. Rev. Stat. § 127.505
   • 1.2 Or. Rev. Stat. § 127.515
   • 1.3 Or. Rev. Stat. § 127.545

Mara Erlach

Writer & Attorney

Mara has been practicing estate planning and trust law in California since 2003, taking pride in helping clients of all backgrounds and asset profiles form a complete and customized estate plan. Her specialties are: estate planning, wills and trusts, trust and probate administration.