Oregon Advance Directive

Information you will need

• Principal Name
• Principal DOB
• Principal Home Phone Number
• Principal Work Phone Number
• Principal Cell Phone Number
• Principal Address
• Principal Email
• Representative Relationship
• Representative Home Phone Number
• Representative Work Phone Number
• Representative Cell Phone Number
• Representative Address
• Representative Email
• Alternate Representative (1) Name
• Alternate Representative (1) Relationship
• Alternate Representative (2) Relationship
• Alternate Representative (1) Work Phone Number
• Alternate Representative (1) Home Phone Number
• Alternate Representative (1) Cell Phone Number
• Alternate Representative (1) Email
• Alternate Representative (2) Name
• Alternate Representative (2) Home Phone Number
• Alternate Representative (2) Work Phone Number
• Alternate Representative (2) Cell Phone Number

…and 24 more fields in the PDF.

Completed by the provider.

The form includes a notary acknowledgment, a witness section.

The document text refers to the laws of Oregon.