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Oregon Advance Directive for Health Care Form

The appointed representative makes health care decisions when you cannot make them yourself, subject to the directive and Oregon law.

Jurisdiction
Oregon
Purpose
Medical & health care
Source / form version
OHA 3905 — January 4, 2022
Resource format
PDF
Signing
Sign and date, with two eligible witnesses OR a notary. The health care representative must accept the appointment.
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Sources checked: 2026-11-13. General information, not individual legal advice.

Use Oregon’s current-format directive

The Oregon Health Authority’s form lets you name a health care representative and alternates, describe treatment preferences and explain the values behind them. The linked hospital-hosted copy preserves the OHA form number and revision. It includes the principal’s signature, witness/notary section and the representatives’ acceptance section; keep these pages together.

Sources: [2] [3]

Explain values as well as treatments

The form includes prompts about what matters to you, preferred care settings, spiritual beliefs and additional information. These details can help a representative interpret unexpected situations. Discuss the completed choices with the people named, and list any attached documents so providers know they are part of your directions.

Sources: [2] [3]

Complete both appointment and acceptance

Use either two eligible witnesses or a notary for your signature. The witnesses cannot be your representative, alternate representative or attending provider. The representative must also accept the appointment, using the form’s acceptance section or other permitted verification. Give copies to your representative and care team after completion, and identify any earlier directive that is replaced.

Sources: [2] [3]

Common questions

Is the representative’s signature just optional contact information?

No. Acceptance is part of making the appointment effective. The form reserves a separate section for the representative and alternates to accept.

Sources: [1] [3]

Is an advance directive the same as POLST?

No. The directive records your choices and representative. POLST is a separate medical-order process; ask your clinician whether it is appropriate for your circumstances.

Sources: [1] [3]

Related forms and guides

Sources and verification

  1. Oregon Health Authority; download copy hosted by Saint Alphonsus: source and instructions (opens in a new tab)
  2. Publisher document download (opens in a new tab)
  3. Applicable state law or official guidance (opens in a new tab)

The OHA source-page link was confirmed; its government file host returned HTTP 503. The Saint Alphonsus copy of OHA 3905 (01/04/2022) was downloaded and all 11 pages inspected, including acceptance and witness/notary pages. It has 70 form fields. The hospital-hosted copy is labeled.

The date above records a source check. It does not certify that a form is suitable for your circumstances or that an attorney has reviewed your document. Read the publisher’s current instructions before use.