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Oregon Advance Directive | Medical POA & Living Will

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The Oregon Advance Directive | Medical POA & Living Will allows an individual residing in Oregon to appoint a Health Care Agent, provide specific treatment preferences directly to attending medical personnel, or both. Once this paperwork is executed, it will become active if the Principal is in a severe medical event where he or she is unable to communicate and decisions on treatments need to be made and applied. Essentially, the Principal issuing this document will be able to fully convey his or her preferences in various scenarios on paper to the parties he or she considers relevant.  This precautionary measure to ensure one’s expectations are met when they suffer a traumatic medical event or succumb to a disease is considered a wise step by many both in and out of the medical field. The Principal will only have to fill out the parts of this document that he or she wishes used, though it is recommended to give some careful thought before filling out and seek a consultation with both the Agent and relevant Health Care Entities.

Definition – ORS 127.505(2)

LawsORS Chapter 127

Durable (Financial) Power of Attorney – Allows an individual to appoint an agent to care for their finances.

How to Write

1 – Save A Copy Of This Template To Your Computer

The paperwork used when delivering the Authority to make Health Care Decisions in Oregon is presented with a preview image on this page. Choose the button with linking to the file format you need to open this form on your machine

2 – State The Principal’s Identity And Intention For This Paperwork’s Lifespan.

After reading the first page, locate the first three lines on the second page (“Name,” “Birthdate,” and “Address”). These items will refer to the Principal’s information and should be used to record the Full Name of the person who is appointing a Health Care Agent with the Authority to make Medical Decisions on his or her behalf on his or her, the Principal’s Date of Birth, and the Principal’s Address. These items should be presented so they match what is written on the Principal’s I.D. cards or official paperwork.

Now, the Principal must deliver his or her intention for how long he or she expects this document to remain active. That is, how long will the Health Care Agent have Principal Power? Find the sentence “Unless Revoked Or Suspended, This Advance Directive Will Continue For.” If the Principal intends these Powers to remain in effect for his or her “Entire Life” then he or she will need to initial the first blank space here. If there is a period of years, the Principal should initial the blank line labeled “Other Period,” then record the number of years (starting from the Signature Date) when this paperwork’s Effect is active.

2 – Name The Health Care Representative As Well As Any Desire Alternate Agent

The Health Care Agent the Principal wishes to grant Medical Authority to will need to be designated in the next part of this document. Enter the Health Care Representative’s Full Name on the first blank line in “Part B: Appointment Of Health Care Representative” The two lines following this will require, first the Health Care Representative’s Complete Address and, second, the Health Care Representative’s current Telephone Number.In the section immediately following, the Principal can designate an Alternate Agent. That is, a back-up who can step up and handle the Principal’s Medical Decisions when the Principal cannot make them on his or her own and the Health Care Representative is unable (for any reason) to fulfill the responsibility this role entails. 3 – The Principal’s Preferences Must Be Presented As Approved Directives

Part B will continue with the Health Care Representative report by documenting what Principal Directives he or she should follow. This section will begin with the label “1. Limits.” Any instructions the Principal wishes the Health Care Representative should be documented here. Generally, anything may be discussed here. A report of any limitations the Health Care Representative should observe or any placed upon the Health Care Agent should be documented in this item. Also discussed here will be any conditions that should be placed upon the Health Care Representative’s implementation of the next several items in this part. If this document will also be delivered to Physicians and the Principal requires the Health Care Representative to follow it precisely as written, the Principal should initial the statement “I Have Executed A Health Care Instruction Or Directive To Physicians…”If the Principal wishes the Health Care Representative to make decisions regarding whether Life Support should be provided to keep him or her alive as part of Medical Care, then he or she should initial the blank line in “2. Life Support.” The Agent will not be able to make any decisions regarding such matters if this line is not initialed.The Principal can grant the Health Care Representative with the Authority to decide on whether he or she should receive Nutrition and Hydration intravenously or through other artificial methods by initialing the blank line in “3. Tube Feeding”The Principal must finalize this part with a Dated Signature to officially appoint the Health Care Representative (even if items 1 through 3 are left blank). The Principal should enter the Current Date on the line labeled “Date.” Below this, the Grantor of Health Care Powers should sign the blank line below the words “Sign Here To Appoint A Health Care Representative”Now that both parties have been identified and the Agent’s Abilities have been discussed, some additional Principal Instructions for specific scenarios may be addressed. We will begin with the scenario “1. Close To Death.” If the Principal is having a Medical Event where he or she is close to Death, he or she can indicate whether “Tube Feeding” is allowed or not. If so, then he or she should initial the first blank line in “A.” If this should be left up to the physician, the Principal should initial the second blank line. If the Principal does not want Tube Feeding at all (Note: This typically results in starvation), then he or she should initial the last line.In “B,” the Principal may indicate if he or she wishes to receive Life Support in this scenario by initialing the first blank line, if it should be left up to the Physician by initialing the second statement, or if Life Support should be denied altogether by initialing the third blank line.The next discussed scenario, “2. Permanently Unconscious,” shall focus on the Principal’s expectations if he or she is in a long-term or permanent vegetative state. The Principal can indicate that he or she wishes to receive Tube Feeding in this scenario by initialing the first blank line, if the Physician should decide by initialing the second blank line, or if Tube Feeding should be denied by initialing the third blank line.  The Principal may also indicate if Life Support should be received, if the Physician’s recommendations should be followed, or if Life Support should be withheld by initialing the first, second, or third blank line (respectively).In the next item, “3. Advanced Progressive Illness,” the Principal will deal with a scenario where a fatal illness has reached an advanced state preventing the Principal from communicating, eating, drinking, from being self-sufficient, recognizing family members, and will likely result in death. The Principal must use the two areas, labeled “A” and “B,” to indicate whether he or she would like to receive Tube Feeding and/or Life Support, follow a Physician’s recommendations in these matters, or deny Tube Feeding and/or Life Support by initialing the appropriate blank lines in these areas.In “4. Extraordinary Suffering,” the Principal will demonstrate his preference regarding Tube Feeding and Life Support by initialing the first, second, or third blank line in “A” to solidify his or her desire to receive Tube Feeding, follow the Physician’s Recommendations, or refuse Tube Feeding when he or she is permanently in severe pain. Similarly, the Principal can show his or her preference in accepting Life Support, letting the Physician decide whether Life Support should be administered, or refuse it by initialing the first, second, or third blank lines in “B.”The Principal can also choose to deny Tub Feeding and Life Support in all the previously described scenarios by simply initialing the blank line in “5. General Instructions”Any additional instructions the Principal wishes followed in these scenarios should be recorded in full on the blank lines in “6. Additional Conditions Or Instructions.”The Principal must indicate if there are any Health Care Powers of Attorney in Effect and what their status should be after the execution of this document. If the Principal has issued previous Health Care Powers and wishes only the most recent one to remain in Effect when this is executed, then he or she should mark the first blank line in “7. Other Documents.” If any previous Health Care Powers are in existence and should automatically be revoked through the execution of this document, the Principal must initial the second blank line. If no such document exists, he or she should initial the third blank line.After these items have been addressed, the Principal should enter the current Date then sign his or her Name on the “Date” line and “Signature” line respectively.

4 – Witnesses Are Required To Substantiate The Principal Signing

In “Part D: Declaration Of Witnesses,” a qualifying Witness must Signe his or her Name and Record the Date of Signing on one of the blank lines “Signature Of Witness/Date” then, print his or her Name on the adjacent line “Printed Name Of Witness.” There will be enough room for two qualifying Witnesses to provide such items. A qualifying Witness is someone who has viewed the Principal signing, is known to the Principal, believes him or her to be capable of such an execution, and does not function as the Principal’s Health Care Provider or Physician in any capacity. At least one Witness must not be the Principal’s relative (in any way) and neither cannot be employed where the Principal receives Medical Care.

5 – The Health Care Representative Must Fulfill His Or Her Requirement

In “Part E. Acceptance By Health Care Representative,” both the Health Care Representative and Alternate Agent must read the statement provided. The Health Care Representative will need to sign his or her Name then Print it on the blank lines labeled “Signature Of Health Care Representative/Date” and “Printed Name” The Alternate Agent must sign his or her Name on the line labeled “Signature Of Alternate Health care Representative/Date” and “Printed Name”

 


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