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Other Names: Oregon Healthcare POA Oregon Healthcare Power of Attorney Oregon Medical POA Oregon Healthcare Proxy
Oregon Medical Power of Attorney document preview

What is an Oregon Medical Power of Attorney?

An Oregon Medical Power of Attorney is a legal document that gives a selected person or entity permission to make health-related decisions for you, such as refusing or accepting a certain medical treatment or procedure, if you cannot do so. 
The individual granting permission is known as the "principal," while the individual or organization gaining authority is known as the "agent." Designed for residents of Oregon, this Power of Attorney for health care can be used in Multnomah County, Washington County, Clackamas County, and in every other region in the state. All Oregon Healthcare PoA forms from Rocket Lawyer can be completely customized for your unique scenario. This official document will provide confirmation to medical providers and other parties that your selected representative(s) can act in your interest when you are not able.

When to use an Oregon Medical Power of Attorney:

  • You want to make sure someone you trust is in charge of your healthcare.
  • You have health concerns, such as declining health or a terminal illness, and are preparing for the future.

Sample Oregon Medical Power of Attorney

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(You do not have to fill out and sign this form.)




This is an important legal document. It can control critical decisions about your health care. Before signing, consider these important facts:


APPOINTING A HEALTH CARE REPRESENTATIVE: You have the right to name a person to direct your health care when you cannot do so. This person is called your "health care representative." You can do this by using Part B of this form. Your representative must accept on Part D of this form.


You can write in this document any restrictions you want on how your representative will make decisions for you. Your representative must follow your desires as stated in this document or otherwise made known. If your desires are unknown, your representative must try to act in your best interest. Your representative can resign at any time.


FACTS ABOUT COMPLETING THIS FORM. This form is valid only if you sign it voluntarily and when you are of sound mind. If you do not want a healthcare power of attorney, you do not have to sign this form.


Unless you have limited the duration of this healthcare power of attorney, it will not expire. If you have set an expiration date, and you become unable to direct your health care before that date this healthcare power of attorney will not expire until you are able to make those decisions again.


You may revoke this document at any time. To do so, notify your representative and your health care provider of the revocation.


Despite this document, you have the right to decide your own health care as long as you are able to do so.


If there is anything in this document that you do not understand, ask a lawyer to explain it to you.


Witnesses must sign Part C.



Principal Name:



Date of Birth:


Unless revoked or suspended, this Healthcare Power of Attorney will continue for (initial one):


_____ My entire life


_____ Other period:





I appoint , as my health care representative. My representative's address is , , , and telephone number is .


I appoint , as my alternate health care representative. My alternate's address is , , , and telephone number is .


I authorize my representative (or alternate) to direct my health care when I can't do so.


Note: You may not appoint your doctor, an employee of your doctor, or an owner, operator or employee of your health care facility, unless that person is related to you by blood, marriage or adoption or that person was appointed before your admission into the health care facility.


. LIMITS. Special conditions or instructions:




_____ I have executed a Health Care Instruction or Directive to Physicians. My representative is to honor it.


. LIFE SUPPORT. "Life Support" refers to any medical means for maintaining life, including procedures, devices and medications. If you refuse life support, you will still get routine measures to keep you clean and comfortable.




_____ My representative may decide about life support for me. (If you don't initial this space, then your representative may not decide about life support.)


. TUBE FEEDING. One sort of life support is food and water supplied artificially by medical device, known as tube feeding.




_____ My representative may decide about tube feeding for me. (If you don't initial this space, then your representative may not decide about tube feeding.)






Signature:___________________________________ Date: ____________






We declare that the person signing this healthcare power of attorney:

(A) Is personally known to us or has provided proof of identity;

(B) Signed or acknowledged that person's signature on this healthcare power of attorney in our presence;

(C) Appears to be of sound mind and not under duress, fraud or undue influence;

(D) Has not appointed either of us as health care representative or alternative representative; and

(E) Is not a patient for whom either of us is attending physician.



Witnessed By:



Signature of Witness:________________________________________


Witness Name:

Date: ___________________________________




Signature of Witness:________________________________________


Witness Name:

Date: ___________________________________



NOTE: One witness must not be a relative (by blood, marriage or adoption) of the person signing this healthcare power of attorney. That witness must also not be entitled to any portion of the person's estate upon death. That witness must also not own, operate or be employed at a health care facility where the person is a patient or resident.





I accept this appointment and agree to serve as health care representative. I understand I must act consistently with the desires of the person I represent, as expressed in this healthcare power of attorney or otherwise made known to me. If I do not know the desires of the person I represent, I have a duty to act in what I believe in good faith to be that person's best interest. I understand that this document allows me to decide about that person's health care only while that person cannot do so. I understand that the person who appointed me may revoke this appointment. If I learn that this document has been suspended or revoked, I will inform the person's health care provider if known to me.



Signature of

Health Care Representative:________________________________________


Representative Name:

Date: ___________________________________




Signature of Alternate

Health Care Representative: ________________________________________


Representative Name:

Date: ___________________________________

Oregon Medical Power of Attorney FAQs

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  • Can I get an Oregon Medical Power of Attorney form online for free?

    It's very easy to assign or receive the authority you might need with a free Oregon Medical Power of Attorney template from Rocket Lawyer:

    1. Make the PoA - Provide a few details and we will do the rest
    2. Send or share - Review it with your agent or seek legal advice
    3. Sign it - Optional or not, notarization and witnesses are encouraged

    This route will often be much less expensive than working with your average provider. If needed, you can start this Medical PoA on behalf of your spouse or another family member, and then have them sign it after you've drafted it. Keep in mind that for this document to be considered valid, the principal must be an adult who is mentally competent at the time of signing. In the event that the principal has already been declared incompetent, a court-appointed conservatorship might be required. In such a scenario, it's important for you to speak with a lawyer .

  • Why should I have a Power of Attorney for healthcare in Oregon?

    Anyone who is over 18 years old ought to have a Medical Power of Attorney. Though it is challenging to think about, there could come a day when you are no longer able to make important decisions on your own. Here are a few common circumstances where a PoA might be helpful:

    • You are planning to undergo a medical procedure requiring anesthesia
    • You are getting older or dealing with ongoing health issues
    • You are currently managing a terminal illness
    • You currently reside in or have plans to move into a community care facility

    Whether this Oregon Medical Power of Attorney is being drafted as part of a long-term plan or produced as a result of an urgent issue, witnesses and notarization are strongly encouraged as a best practice for protecting your document if its authority is challenged by a third party.

  • How are an Oregon Healthcare Proxy and an Oregon Medical Power of Attorney different?

    In the process of researching the topics of elder care and/or estate planning, you or a loved one may hear "healthcare power of attorney", "medical power of attorney" and "healthcare proxy" used together. In actuality, they're the same. That said, please keep in mind that it is certainly possible to give agency over matters that are not related to health care, in which case, "proxy" is not typically used.

  • Do I need to work with a lawyer to review my Oregon Medical PoA?

    Oregon Medical PoA forms are generally straightforward, but you could still have legal questions. Seeking out an attorney to give feedback on your Oregon Medical Power of Attorney could be fairly time-consuming. An easier alternative would be to request help from the Rocket Lawyer On Call® network of attorneys. With a Premium membership, you can have your documents examined by an Rocket Lawyer network attorney with relevant experience. You can rest assured that Rocket Lawyer is here to support you.

  • How much might I typically pay for an attorney to help me get a Power of Attorney form for health care in Oregon?

    The fees associated with hiring a conventional law firm to produce a Medical Power of Attorney could total anywhere from $200 to $500. When you use Rocket Lawyer, you are not just filling out a Power of Attorney template. In case you ever need support from a lawyer, your Rocket Lawyer membership provides up to 40% in savings when you hire an Rocket Lawyer network attorney.

  • What steps should I take after drafting an Oregon Medical Power of Attorney?

    Attached to your Power of Attorney, there's a series of instructions for what you should do next. Feel free to engage with your PoA in all of these ways: editing it, saving it as a PDF document or Word file, or signing it. Finally, your agent(s) and care providers should get copies of your final document.

  • Does a Medical Power of Attorney need to be notarized, witnessed, and/or recorded in Oregon?

    The guidelines for PoA forms vary by state; however, in Oregon, your document will need to be acknowledged by a notary public or signed by two witnesses. The selected witnesses should not include your attending physician, and at least one should not be related to you (such as a spouse, adopted child, or family member) or any other heir/beneficiary. Finally, as a general principle, your witness(es) should not be under the age of 18, and no witness should simultaneously be your Power of Attorney agent.

    See Oregon Medical/Healthcare Power of Attorney law: ORS 127.510

Oregon Medical Power of Attorney document preview

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