Home Health Resources Advance Directives & POLST Forms
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Discussing & Planning Your Health Care Wishes
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).
Forms & Resources
Oregon Advance Directive for Health Care– English
Oregon Advance Directive for Health Care– Spanish
Oregon Advance Directive in Other Languages
Advance Directives
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’s form also allows you to share some of your values or beliefs that might influence your care.
Getting Started
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.
If you prefer, you can mail or fax your advanced directive to Samaritan’sHealth Information Department or upload it through your MyChart account, learn more below:
Submitting Your Completed Advance Directive
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.
If you prefer, you can mail or fax your advanced directive to Samaritan’sHealth Information Department or upload it through your MyChart account, learn more below:
You can mail or fax an Advance Directive to Samaritan’s Health Information Department at:
Samaritan Health Services
Health Information Department
PO Box 2728
Corvallis, OR 97339
Fax:541-768-9363
Questions? Call Samaritan’s Health Information Department at541-768-5069
or email:[emailprotected].
If you have a MyChart account, you can upload your Advance Directive to your MyChart records. After logging in to your account, click onMenu. UnderMy Recordin the dropdown menu, select End-of-Life Planning. You can upload your Advance Directive on this page.
Log into MyChart
Attend an Advance Directive Workshop
See the Schedule
POLST Forms
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.
For more information on the Oregon POLST Registry, call877-367-7657or email[emailprotected].
Completing a POLST Form
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.
Talk to your health care team if you want to change or revoke a POLST.
How Does an Advance Directive & POLST Form Differ?
| Advance Directive | POLST | |
|---|---|---|
| Who is it for? | Everyone 18 and older. | People with a serious illness or who are very old and frail. |
| What kind of document is it? | It is a legal document. | It is a medical order. |
| Who signs it? | You fill it out and must sign it in front of a witness or a notary. Your health care representative should also sign it. | Your doctor* fills it out with your input then signs it. |
| Do I need a lawyer? | No. | No. |
| Who keeps the form? | You keep the original where loved ones can find it. You give a copy to your health care representative and your doctor. | Your doctor’s office keeps it and enters it into the electronic Oregon POLST Registry. |
| Can I change the form if I change my mind? | 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. | Yes. You can ask for an appointment with your doctor to change it. |
| What if there is a medical emergency and I cannot speak for myself? | Your health care representative speaks for you and honors your wishes. | The ambulance staff, hospital staff and doctors look for the medical orders in the electronic database and follow them. |
More Information
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.
- Good Samaritan Regional Medical Center:541-768-5084
- Samaritan Albany General Hospital:541-812-4184
- Samaritan Lebanon Community Hospital:541-451-7129
- Samaritan North Lincoln Hospital:541-557-7221
- Samaritan Pacific Communities Hospital:541-574-4751
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