Advance care planning

Advance directives

As a patient at Salem Health Hospitals & Clinics, you have a legal right to complete an advance directive. We honor your right to complete an advance directive and to review and revise your advance directive while in care or through your primary care physician.

The Oregon Advance Directive is a legal document where you indicate who you would like to make your health care decisions if you cannot make them for yourself. Additionally, on the document you are asked to indicate your health care goals, preferences, and instructions for specific situations so the medical team and your decision makers are aware of your wishes.

The person you choose is called your health care representative; they are given temporary authority to make health care decisions on your behalf only if providers determine you are incapable of making health care decisions for yourself. The decisions made by your health care representative should be consistent with your wishes, values and goals.

If you need help completing or updating an advance directive during your hospital stay, our staff will arrange for assistance. 

It is very important to have a copy of your Oregon Advance Directive in your medical record. Please email, mail or fax a copy of your Oregon Advance Directive to:


Salem Health Hospitals & Clinics
ATTN: HIM Department
890 Oak St. SE, Salem, OR 97302
Fax: 503-814-2728


The Advance Directive document will be uploaded to your electronic medical record and be available to most of your health care providers and hospitals in the area. You may also upload a copy via your MyChart account.

If you don't have an advance directive, you may consider this opportunity to create one – before you need it. Our explanation packet and workbook will help you start conversations and consider real health care situations that your family may be faced with.



Advance directive explanation packet (pdf)


Advance directive workbook (pdf)


Click here for all Oregon Advance Directives forms and explanation booklets in various languages.



Salem Health will never decline to provide treatment whether you have an advance directive or not. This form simply helps us understand what treatment you would or wouldn’t want based upon your beliefs and values. The document will never take the place of your decisions while you are able to participate. Also, you can change your mind (and this form) at any time as long as you are able. Health care providers only use this form when you can no longer speak for yourself. It also tells us who you would like us to contact to help make decisions for you – what we call a health care representative.

If you have an upcoming, planned admission, you will be offered a free copy of an advance directive at the time of your registration.

Helpful Resources

Understanding Your Code Status 
This Salem Health video link provides more information on something the hospital calls “code status” or how your care team should respond if your heart stops or you stop breathing unexpectedly. It provides specific information on cardiopulmonary resuscitation and a breathing machine.

Oregon POLST
What patients and their surrogates need to know.

The Conversation Project
This website offers tools, guidance and resources on how to begin the conversation about care through the end of life with your loved ones.

Honoring Choices

This website offers tools, resources and guidance to help adults understand advance care planning.

Five Wishes
An Advance Directive organization that also addresses desires for spiritual, emotional and personal care in a clear and easy way to understand.

National Institute on Aging - Advance Care Planning
Offers videos, free brochures, tools and guidance to understand advance care planning and health care directives.