{"id":10000,"date":"2023-08-31T11:09:09","date_gmt":"2023-08-31T18:09:09","guid":{"rendered":"https:\/\/samhealth.org\/?page_id=10000"},"modified":"2026-04-14T11:32:43","modified_gmt":"2026-04-14T18:32:43","slug":"advance-directives-polst-forms","status":"publish","type":"page","link":"https:\/\/samhealth.org\/patient-visitors\/health-resources\/advance-directives-polst-forms\/","title":{"rendered":"Advance Directives &amp; POLST Forms"},"content":{"rendered":"\n<section id=\"block_04bf07a377bf6b196fa6008df6c35f98\" class=\"shs-block block-section grid-container has-blue-light-background-color\" >\n\t\t<div class=\"entry-content\">\n\n<h1 class=\"wp-block-heading\" id=\"h-advance-directives-amp-polst-forms\">Advance Directives &amp; POLST Forms<\/h1>\n\n<\/div>\n\t<\/section>\n\n\n<nav id=\"block_bad65ea0aac6811c721d789d4ec3c8d8\" class=\"shs-block in-content-nav-links grid-container has-blue-midnight-background-color\">\n\t<button class=\"in-content-nav-title has-blue-midnight-background-color js-in-page-nav-toggle\">On This Page\t<svg id=\"icon_menu\" class=\"\" viewBox=\"0 0 22 22\">\n\t\t<defs><style>#icon_menu_hit_box{fill:transparent;}#bot{transform-origin: 10% 70%;}#top{transform-origin: 15% 30%;}.im1{fill:#7999B9;}<\/style><\/defs>\n\t\t<title>Related Content Menu<\/title>\n\t\t<rect id=\"top\" class=\"im1 will-ease\" y=\"2.5\" width=\"22\" height=\"3\"\/>\n\t\t<rect id=\"mid\" class=\"im1 hide-when-open\" y=\"9.5\" width=\"22\" height=\"3\"\/>\n\t\t<rect id=\"bot\" class=\"im1 will-ease\" y=\"16.5\" width=\"22\" height=\"3\"\/>\n\t\t<rect id=\"icon_menu_hit_box\" width=\"22\" height=\"22\" \/>\n\t<\/svg>\n<\/button>\n\t\t<ul>\n\t\t\t\t<li>\n\t\t\t<a href=\"#Advance\" target=\"_self\">Advance Directives<\/a>\n\t\t<\/li>\n\t\t\t\t\t\t\t\t<li>\n\t\t\t<a href=\"#Polst\" target=\"_self\">POLST Forms<\/a>\n\t\t<\/li>\n\t\t\t\t\t\t<li>\n\t\t\t<a href=\"#Compare\" target=\"_self\">More Information<\/a>\n\t\t<\/li>\n\t\t\t\t\t\t\t<\/ul>\n<\/nav>\n\n\n\n<section id=\"block_644aca1855556e4fd911967d6b141317\" class=\"shs-block block-section grid-container has-white-background-color\" >\n\t\t<div class=\"entry-content\">\n\n<h2 class=\"wp-block-heading\">Discussing &amp; Planning Your Health Care Wishes<\/h2>\n\n\n\n<p>Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals and preferences regarding future medical care. It involves conversations about these topics and can involve documentation of these preferences in an advance directive or POLST (portable orders for life-sustaining treatment).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Forms &amp; Resources<\/h2>\n\n\n\n<p><a href=\"https:\/\/sharedsystems.dhsoha.state.or.us\/DHSForms\/Served\/le3905.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Oregon Advance Directive for Health Care<\/a>&nbsp;&#8211; English<\/p>\n\n\n\n<p><a href=\"https:\/\/sharedsystems.dhsoha.state.or.us\/DHSForms\/Served\/ls3905.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Oregon Advance Directive for Health Care<\/a>&nbsp;&#8211; Spanish<\/p>\n\n\n\n<p><a href=\"https:\/\/www.oregon.gov\/oha\/ph\/about\/pages\/adac-forms.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">Oregon Advance Directive in Other Languages<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/sharedsystems.dhsoha.state.or.us\/DHSForms\/Served\/le3942.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Your Guide to the Oregon Advance Directive for Health Care<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/oregonpolst.org\/patients-family\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oregon POLST Information for Patients and Families<\/a><\/p>\n\n<\/div>\n\t<\/section>\n\n\n\n<section id=\"Advance\" class=\"shs-block block-section grid-container has-blue-light-background-color has-circle-image\" >\n\t\t\t<figure class=\"image\"\n\t\t\t\t\t\t>\n\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"684\" height=\"684\" src=\"https:\/\/samhealth.org\/wp-content\/uploads\/2023\/09\/couple-hiking-in-the-mountains-304-BGC.jpg\" class=\"attachment-square-lg size-square-lg\" alt=\"Asian woman and man hiking\" srcset=\"https:\/\/samhealth.org\/wp-content\/uploads\/2023\/09\/couple-hiking-in-the-mountains-304-BGC.jpg 684w, https:\/\/samhealth.org\/wp-content\/uploads\/2023\/09\/couple-hiking-in-the-mountains-304-BGC-300x300.jpg 300w, https:\/\/samhealth.org\/wp-content\/uploads\/2023\/09\/couple-hiking-in-the-mountains-304-BGC-150x150.jpg 150w, https:\/\/samhealth.org\/wp-content\/uploads\/2023\/09\/couple-hiking-in-the-mountains-304-BGC-425x425.jpg 425w, https:\/\/samhealth.org\/wp-content\/uploads\/2023\/09\/couple-hiking-in-the-mountains-304-BGC-100x100.jpg 100w\" sizes=\"auto, (max-width: 684px) 100vw, 684px\" \/>\t\t<\/figure>\n\t\t<div class=\"entry-content\">\n\n<h2 class=\"wp-block-heading\">Advance Directives<\/h2>\n\n\n\n<p>An advance directive can be completed by any person 18 years or older. It helps you to identify a health care representative and tells that person and your medical team what kind of care you would like to have. It is used when you are not able to speak for yourself or make your own medical decisions. When you are ill, an advance directive states what type of treatment you would prefer if you are unlikely to recover. Oregon\u2019s form also allows you to share some of your values or beliefs that might influence your care.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Getting Started<\/h2>\n\n\n\n<p>An advance directive can be completed by filling out a document you get from your medical provider, hospital or online; or by working with an attorney.<\/p>\n\n\n\n<p>If you prefer, you can mail or fax your advanced directive to Samaritan\u2019s&nbsp;Health Information Department or upload it through your MyChart account, learn more below:<\/p>\n\n<\/div>\n\t<\/section>\n\n\n\n<section id=\"block_04bf07a377bf6b196fa6008df6c35f98\" class=\"shs-block block-section grid-container has-blue-light-background-color\" >\n\t\t<div class=\"entry-content\">\n\n<h2 class=\"wp-block-heading\">Submitting Your Completed Advance Directive<\/h2>\n\n\n\n<p>Once you have completed your advance directive, you can bring a copy to any Samaritan Health Services clinic or hospital to be scanned into your electronic medical record. It is also helpful to give copies to your health care representatives and other immediate family members so they know your wishes. Be sure to keep the original form in a safe place. Your advance directive can be changed or revoked at any time.<\/p>\n\n\n\n<p>If you prefer, you can mail or fax your advanced directive to Samaritan\u2019s&nbsp;Health Information Department or upload it through your MyChart account, learn more below:<\/p>\n\n\n<section id=\"block_bfa6a12806baf47d855ee3aa38861232\" class=\"shs-block two-columns\">\n<div class=\"entry-content two-column-grid\">\n<div class=\"entry-content shs-block column\">\n\n<div id=\"block_3b6165e4474a2521ae7ca099a5f1de73\" class=\"shs-block accordion is-style-fill\">\n\t<h3 class=\"accordion-title\">\n\t\t<button\n\t\t\ttype=\"button\"\n\t\t\tid=\"accordion_title_69f1de477d1215.15254778\"\n\t\t\tclass=\"accordion-control\" aria-expanded=\"false\"\n\t\t\taria-controls=\"accordion_panel_69f1de477d1264.94946072\">Submit by Mail or Fax <span class=\"iconfont-chevron-right\"><\/span><\/button>\n\t<\/h3>\n\t<section\n\t\tid=\"accordion_panel_69f1de477d1264.94946072\"\n\t\tclass=\"accordion-panel\"\n\t\taria-labelledby=\"accordion_title_69f1de477d1215.15254778\" style=\"height:0\">\n\t\t<div class=\"entry-content\">\n\n<p>You can mail or fax an Advance Directive to Samaritan\u2019s Health Information Department at:<\/p>\n\n\n\n<p>Samaritan Health Services<br>Health Information Department<br>PO Box 2728<br>Corvallis, OR 97339<\/p>\n\n\n\n<p><strong>Fax:<\/strong>&nbsp;<a href=\"tel:541-768-9363\">541-768-9363<\/a><\/p>\n\n\n\n<p>Questions? Call Samaritan\u2019s Health Information Department at&nbsp;<a href=\"tel:541-768-5069\">541-768-5069<\/a><br>or email:&nbsp;<a href=\"mailto:shshimroi@samhealth.org?subject=Advance%20Directive\">shshimroi@samhealth.org<\/a>.<\/p>\n\n<\/div>\n\t<\/section>\n<\/div>\n\n<\/div>\n\n\n<div class=\"entry-content shs-block column\">\n\n<div id=\"block_df0e6ead3d433a2600a94964debd1421\" class=\"shs-block accordion is-style-fill\">\n\t<h3 class=\"accordion-title\">\n\t\t<button\n\t\t\ttype=\"button\"\n\t\t\tid=\"accordion_title_69f1de477ec500.87765338\"\n\t\t\tclass=\"accordion-control\" aria-expanded=\"false\"\n\t\t\taria-controls=\"accordion_panel_69f1de477ec553.20885681\">Submit Through MyChart <span class=\"iconfont-chevron-right\"><\/span><\/button>\n\t<\/h3>\n\t<section\n\t\tid=\"accordion_panel_69f1de477ec553.20885681\"\n\t\tclass=\"accordion-panel\"\n\t\taria-labelledby=\"accordion_title_69f1de477ec500.87765338\" style=\"height:0\">\n\t\t<div class=\"entry-content\">\n\n<p>If you have a MyChart account, you can upload your Advance Directive to your MyChart records. After logging in to your account, click on&nbsp;<strong>Menu<\/strong>. Under&nbsp;<strong>My Record<\/strong>&nbsp;in the dropdown menu, select End-of-Life Planning. You can upload your Advance Directive on this page.<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/mychart.samhealth.org\/MyChart\/Authentication\/Login?\" target=\"_blank\" rel=\"noreferrer noopener\">Log into MyChart<\/a><\/div>\n<\/div>\n\n<\/div>\n\t<\/section>\n<\/div>\n\n<\/div>\n\n<\/div>\n<\/section>\n\n<\/div>\n\t<\/section>\n\n\n\n<section id=\"block_5fd9dbef7280ddd3990a147ee3cf11ba\" class=\"shs-block block-slim-section grid-container has-white-background-color\">\n\n\t<div class=\"entry-content\">\n\n<h2 class=\"wp-block-heading\" id=\"h-attend-an-advance-directive-workshop\">Attend an Advance Directive Workshop<\/h2>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/samhealth.org\/events\/list\/?tribe-bar-search=advance+directive\" target=\"_blank\" rel=\"noreferrer noopener\">See the Schedule<\/a><\/div>\n<\/div>\n\n<\/div>\n\n\t<\/section>\n\n\n\n<section id=\"Polst\" class=\"shs-block block-section grid-container has-gray-warm-background-color has-circle-image col-reverse\" >\n\t\t\t<figure class=\"image\"\n\t\t\t\t\t\t>\n\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"684\" height=\"684\" src=\"https:\/\/samhealth.org\/wp-content\/uploads\/2023\/09\/smiling-older-woman-in-wheelchair-304-BGC.jpg\" class=\"attachment-square-lg size-square-lg\" alt=\"Elderly white woman in a wheel chair holding someone&#039;s hand.\" srcset=\"https:\/\/samhealth.org\/wp-content\/uploads\/2023\/09\/smiling-older-woman-in-wheelchair-304-BGC.jpg 684w, https:\/\/samhealth.org\/wp-content\/uploads\/2023\/09\/smiling-older-woman-in-wheelchair-304-BGC-300x300.jpg 300w, https:\/\/samhealth.org\/wp-content\/uploads\/2023\/09\/smiling-older-woman-in-wheelchair-304-BGC-150x150.jpg 150w, https:\/\/samhealth.org\/wp-content\/uploads\/2023\/09\/smiling-older-woman-in-wheelchair-304-BGC-425x425.jpg 425w, https:\/\/samhealth.org\/wp-content\/uploads\/2023\/09\/smiling-older-woman-in-wheelchair-304-BGC-100x100.jpg 100w\" sizes=\"auto, (max-width: 684px) 100vw, 684px\" \/>\t\t<\/figure>\n\t\t<div class=\"entry-content\">\n\n<h2 class=\"wp-block-heading\">POLST Forms<\/h2>\n\n\n\n<p>POLST stands for portable orders for life-sustaining treatment. The POLST form is a medical order intended for patients with advanced illness or who are older and frail and may want to limit possible life-saving medical treatment. The POLST form turns your wishes regarding CPR and the use of life-support machines into medical orders. The POLST form is signed by a physician, nurse practitioner or physician assistant. Your POLST form will be registered with the Oregon POLST Registry unless you opt out. The registry is designed to assist emergency medical personnel in accessing your POLST form if the physical copy cannot be immediately found.<\/p>\n\n\n\n<p>For more information on the Oregon POLST Registry, call&nbsp;<a href=\"tel:877-367-7657\">877-367-7657<\/a>&nbsp;or email&nbsp;<a href=\"mailto:polst@ohsu.edu?subject=More%20Information%20About%20the%20Registry\">polst@ohsu.edu<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Completing a POLST Form<\/h2>\n\n\n\n<p>A POLST is completed after having a conversation with a trained member of your health care team. It must be signed by your physician, nurse practitioner or physician assistant.<\/p>\n\n\n\n<p>Talk to your health care team if you want to change or revoke a POLST.<\/p>\n\n<\/div>\n\t<\/section>\n\n\n\n<section id=\"Compare\" class=\"shs-block block-section grid-container has-white-background-color\" >\n\t\t<div class=\"entry-content\">\n\n<h2 class=\"wp-block-heading\">How Does an Advance Directive &amp; POLST Form Differ?<\/h2>\n\n\n\n<figure class=\"wp-block-table is-style-color\"><table><thead><tr><th>&nbsp;<\/th><th>Advance Directive<\/th><th>POLST<\/th><\/tr><\/thead><tbody><tr><th>Who is it for?<\/th><td>Everyone 18 and older.<\/td><td>People with a serious illness or who are very old and frail.<\/td><\/tr><tr><th>What kind of document is it?<\/th><td>It is a legal document.<\/td><td>It is a medical order.<\/td><\/tr><tr><th>Who signs it?<\/th><td>You fill it out and must sign it in front of a witness or a notary. Your health care representative should also sign it.<\/td><td>Your doctor* fills it out with your input then signs it.<\/td><\/tr><tr><th>Do I need a lawyer?<\/th><td>No.<\/td><td>No.<\/td><\/tr><tr><th>Who keeps the form?<\/th><td>You keep the original where loved ones can find it. You give a copy to your health care representative and your doctor.<\/td><td>Your doctor\u2019s office keeps it and enters it into the electronic Oregon POLST Registry.<\/td><\/tr><tr><th>Can I change the form if I change my mind?<\/th><td>Yes. You can tear up the old one. Then write a new one where loved ones can find it. You give a copy to your health care representative and your doctor.<\/td><td>Yes. You can ask for an appointment with your doctor to change it.<\/td><\/tr><tr><th>What if there is a medical emergency and I cannot speak for myself?<\/th><td>Your health care representative speaks for you and honors your wishes.<\/td><td>The ambulance staff, hospital staff and doctors look for the medical orders in the electronic database and follow them.<\/td><\/tr><\/tbody><\/table><figcaption class=\"wp-element-caption\"><sup>*Doctor means someone who can sign a POLST.&nbsp; A POLST can be signed by a physician, nurse practitioner or physician assistant.<\/sup><\/figcaption><\/figure>\n\n<\/div>\n\t<\/section>\n\n\n\n<section id=\"block_644aca1855556e4fd911967d6b141317\" class=\"shs-block block-section grid-container has-white-background-color\" >\n\t\t<div class=\"entry-content\">\n\n<h2 class=\"wp-block-heading\">More Information<\/h2>\n\n\n\n<p>If you have questions about the form or just want to learn more, talk to your provider or call the Chaplain Services department at your local hospital.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Good Samaritan Regional Medical Center:&nbsp;&nbsp;<a href=\"tel:541-768-5084\">541-768-5084<\/a><\/li>\n\n\n\n<li>Samaritan Albany General Hospital:&nbsp;&nbsp;<a href=\"tel:541-812-4184\">541-812-4184<\/a><\/li>\n\n\n\n<li>Samaritan Lebanon Community Hospital:&nbsp;&nbsp;<a href=\"tel:541-451-7129\">541-451-7129<\/a><\/li>\n\n\n\n<li>Samaritan North Lincoln Hospital:&nbsp;&nbsp;<a href=\"tel:541-557-7221\">541-557-7221<\/a>&nbsp;<\/li>\n\n\n\n<li>Samaritan Pacific Communities Hospital:&nbsp;&nbsp;<a href=\"tel:541-574-4751\">541-574-4751<\/a><\/li>\n<\/ul>\n\n<\/div>\n\t<\/section>\n\n\n\n<section id=\"block_04bf07a377bf6b196fa6008df6c35f98\" class=\"shs-block block-section grid-container has-blue-light-background-color\" >\n\t\t<div class=\"entry-content\">\n\n<p><strong>Need to return to this page?<\/strong>&nbsp; Bookmark it or enter&nbsp;<strong><a href=\"https:\/\/samhealth.org\/patient-visitors\/health-resources\/advance-directives-polst-forms\/\">samhealth.org\/Plan Ahead<\/a><\/strong>&nbsp;in your browser\u2019s search bar.<\/p>\n\n<\/div>\n\t<\/section>\n","protected":false},"excerpt":{"rendered":"<p>Learn about Advance Directives and POLST. Understand the process to make your wishes known to loved ones and your health care team. samhealth.org\/PlanAhead<\/p>\n","protected":false},"author":17,"featured_media":0,"parent":62,"menu_order":5,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_searchwp_excluded":"","_shs_workflow_notes":"","_shs_exclude_from_navigation":false,"_shs_promote_article_on_blogs":"","footnotes":""},"class_list":["post-10000","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/pages\/10000","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/users\/17"}],"replies":[{"embeddable":true,"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/comments?post=10000"}],"version-history":[{"count":1,"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/pages\/10000\/revisions"}],"predecessor-version":[{"id":70853,"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/pages\/10000\/revisions\/70853"}],"up":[{"embeddable":true,"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/pages\/62"}],"wp:attachment":[{"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/media?parent=10000"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}