Oregon Medical Power of Attorney
This document allows you to appoint someone to make medical decisions on your behalf if you are unable to do so. It is governed by the laws of the State of Oregon.
Principal Information:
- Name: ______________________________
- Address: ____________________________
- City, State, Zip: ____________________
- Date of Birth: _______________________
Agent Information:
- Name: ______________________________
- Address: ____________________________
- City, State, Zip: ____________________
- Phone Number: _______________________
Durability of Power of Attorney:
This Medical Power of Attorney shall remain in effect even if I become incapacitated.
Authority Granted:
I grant my Agent the authority to make decisions regarding my medical care, including but not limited to:
- Choosing healthcare providers
- Consenting to or refusing medical treatment
- Accessing my medical records
Limitations on Authority:
My Agent shall not have authority to:
- Make decisions regarding organ donation
- Make decisions regarding life-sustaining treatment if I am in a terminal condition
Signature:
By signing below, I confirm that I am of sound mind and that I understand the contents of this document.
Signature of Principal: ____________________________
Date: _____________________________________________
Witnesses:
This document must be signed in the presence of two witnesses who are not related to the Principal or the Agent.
- Witness 1 Name: ___________________________
- Witness 1 Signature: ________________________
- Witness 2 Name: ___________________________
- Witness 2 Signature: ________________________
Notary Public:
State of Oregon
County of ______________________
Subscribed and sworn before me on this ____ day of __________, 20__.
Notary Public Signature: ______________________
My Commission Expires: ______________________