Title 127 · ORS Chapter 127

419C.530. �� (c) In cases of emergency endangering life or health. �� (2) A declaration does not limit any authority provided in ORS 426.005 to 426.390 either to take a person into custody, or

Citation: ORS 419C.530

Section: 419C.530

419C.530.

�� (c) In cases of emergency endangering life or health.

�� (2) A declaration does not limit any authority provided in ORS 426.005 to 426.390 either to take a person into custody, or to admit, retain or treat a person in a health care facility. [1993 c.442 �9; 1995 c.141 �2; 2009 c.595 �88; 2011 c.279 �1; 2021 c.33 �1]

�� 127.722 Revocation of declaration. (1) A declaration may be revoked in whole or in part at any time by the principal if the principal is not incapable. A revocation is effective when a capable principal communicates the revocation to the attending physician or other provider. The attending physician or other provider shall note the revocation as part of the principal�s medical record.

�� (2) The authority of the principal�s spouse as attorney-in-fact is revoked if a petition for dissolution or annulment of marriage is filed, the principal is not incapable and the principal or the court does not reaffirm the appointment after the filing of the petition. [1993 c.442 �10; 2014 c.45 �18; 2021 c.272 �5]

�� 127.725 Limitations on liability of physician or provider. A physician or provider who administers or does not administer mental health treatment according to and in good faith reliance upon the validity of a declaration is not subject to criminal prosecution, civil liability or professional disciplinary action resulting from a subsequent finding of a declaration�s invalidity. [1993 c.442 �11]

�� 127.727 Persons prohibited from serving as attorney-in-fact. (1) None of the following may serve as attorney-in-fact:

�� (a) The attending physician or provider or an employee of the physician or provider, if the physician, provider or employee is unrelated to the principal by blood, marriage or adoption.

�� (b) An owner, operator or employee of a health care facility in which the principal is a patient or resident, if the owner, operator or employee is unrelated to the principal by blood, marriage or adoption.

�� (c) A person who is the principal�s parent, guardian or former guardian if:

�� (A) At any time while the principal was under the care, custody or control of the person, a court entered an order:

�� (i) Taking the principal into protective custody under ORS 419B.150; or

�� (ii) Committing the principal to the legal custody of the Department of Human Services for care, placement and supervision under ORS 419B.337; and

�� (B) The court entered a subsequent order that:

�� (i) The principal should be permanently removed from the person�s home, or continued in substitute care, because it was not safe for the principal to be returned to the person�s home, and no subsequent order of the court was entered that permitted the principal to return to the person�s home before the principal�s wardship was terminated under ORS 419B.328; or

�� (ii) Terminated the person�s parental rights under ORS 419B.500 and 419B.502 to 419B.524.

�� (4) A principal, while not incapable, may petition the court to remove a prohibition contained in subsection (1)(c) of this section. [1993 c.442 �12; 2011 c.194 �4; 2014 c.45 �19]

�� 127.730 [1993 c.442 �13; 2014 c.45 �20; repealed by 2023 c.11 �5]

�� 127.732 Withdrawal of attorney-in-fact; rescission of withdrawal. (1) An attorney-in-fact may withdraw by giving notice to the principal. If a principal is incapable, the attorney-in-fact may withdraw by giving notice to the attending physician or provider. The attending physician or provider shall note the withdrawal as part of the principal�s medical record.

�� (2) A person who has withdrawn under the provisions of subsection (1) of this section may rescind the withdrawal by executing an acceptance after the date of the withdrawal. The acceptance must be in the same form as provided by ORS 127.736 for accepting an appointment. A person who rescinds a withdrawal must give notice to the principal if the principal is capable or to the principal�s health care provider if the principal is incapable. [1993 c.442 �14]

�� 127.735 [1993 c.442 �15; repealed by 1997 c.563 �2 (127.736 enacted in lieu of 127.735)]

�� 127.736 Form of declaration. A declaration for mental health treatment shall be in substantially the following form:

______________________________________________________________________________

DECLARATION FOR

MENTAL HEALTH TREATMENT

�� I, ___________________, being an adult of sound mind, willfully and voluntarily make this declaration for mental health treatment. I want this declaration to be followed if a court or two capacity evaluators determine that I am unable to make decisions for myself because my ability to receive and evaluate information effectively or communicate decisions is impaired to such an extent that I lack the capacity to refuse or consent to mental health treatment. �Mental health treatment� means treatment of mental illness with psychoactive medication, admission to and retention in a health care facility for a given period, convulsive treatment and outpatient services that are specified in this declaration. �Health care facility� could include an inpatient setting, a residential facility, an adult foster home or a hospice program. �Capacity evaluator� means a licensed independent practitioner or a licensed psychologist.

______________________________________________________________________________

CHOICE OF DECISION MAKER

�� If I become incapable of giving or withholding informed consent for mental health treatment, I want these decisions to be made by: (INITIAL ONLY ONE)

�� __� My appointed representative consistent with my desires, or, if my desires are unknown by my representative, in what my representative believes to be my best interests.

�� __� By the mental health treatment provider who requires my consent in order to treat me, but only as specifically authorized in this declaration.

APPOINTED REPRESENTATIVE

�� If I have chosen to appoint a representative to make mental health treatment decisions for me when I am incapable, I am naming that person here. I may also name an alternate representative to serve. Each person I appoint must accept my appointment in order to serve. I understand that I am not required to appoint a representative in order to complete this declaration.

�� I hereby appoint:

�� NAME _________

�� ADDRESS _________

�� TELEPHONE # _________ to act as my representative to make decisions regarding my mental health treatment if I become incapable of giving or withholding informed consent for that treatment.

(OPTIONAL)

�� If the person named above refuses or is unable to act on my behalf, or if I revoke that person�s authority to act as my representative, I authorize the following person to act as my representative:

�� NAME _________

�� ADDRESS _________

�� TELEPHONE # _________

�� My representative is authorized to make decisions that are consistent with the wishes I have expressed in this declaration or, if not expressed, as are otherwise known to my representative. If my desires are not expressed and are not otherwise known by my representative, my representative is to act in what he or she believes to be my best interests. My representative is also authorized to receive information regarding proposed mental health treatment and to receive, review and consent to disclosure of medical records relating to that treatment.

______________________________________________________________________________

DIRECTIONS FOR

MENTAL HEALTH TREATMENT

�� This declaration permits me to state my wishes regarding mental health treatments including psychoactive medications, admission to and retention in a health care facility for mental health treatment for a period not to exceed the number of days specified below, convulsive treatment and outpatient services.

�� If I become incapable of giving or withholding informed consent to be admitted for inpatient mental health treatment, I CONSENT TO BE ADMITTED TO THE FOLLOWING HEALTH CARE FACILITIES:

______________________________________________________________________________

�� If I become incapable of giving or withholding informed consent to be admitted to a health care facility for mental health treatment, and am admitted to a facility listed above, I consent to be admitted when medically necessary for up to: (INITIAL ONLY ONE)

�� _________ 14 days.

�� _________ 30 days.

�� _________ 60 days.

�� _________ ___ days.

�� If I become incapable of giving or withholding informed consent for mental health treatment, I CONSENT TO THE FOLLOWING MENTAL HEALTH TREATMENTS: (May include types and dosage of medications, short-term inpatient treatment, a preferred provider or facility, transport to a provider or facility, convulsive treatment or alternative outpatient treatments.)

______________________________________________________________________________

I DO NOT CONSENT TO THE FOLLOWING MENTAL HEALTH TREATMENT: (Consider including your reasons, such as past adverse reaction, allergies or misdiagnosis. Be aware that a person may be treated without consent if the person is held pursuant to a court order.)

______________________________________________________________________________

ADDITIONAL INFORMATION ABOUT MY MENTAL HEALTH TREATMENT NEEDS: (Consider including mental or physical health history, dietary requirements, religious concerns, people to notify and other matters of importance.)

______________________________________________________________________________

YOU MUST SIGN HERE FOR THIS DECLARATION TO BE EFFECTIVE:

______________________

(Signature/Date)

NOTARY OR WITNESSES

�� (Have this document notarized by a notary public OR have 2 competent adult witnesses complete the Affirmation of Witnesses.)

NOTARIAL CERTIFICATE:

�� State of ____________

�� County of ____________

�� Signed or attested before me on _____,

�� 2___, by _______________.

�� ________________________

�� Notary Public - State of Oregon

AFFIRMATION OF WITNESSES

�� I affirm that the person signing this declaration:

�� (a) Is personally known to me;

�� (b) Signed or acknowledged his or her signature on this declaration in my presence;

�� (c) Appears to be of sound mind and not under duress, fraud or undue influence;

�� (d) Is not related to me by blood, marriage or adoption;

�� (e) Is not a patient or resident in a facility that I or my relative owns or operates;

�� (f) Is not my patient and does not receive mental health services from me or my relative; and

�� (g) Has not appointed me as a representative in this document.

Witnessed by:

______________�� ____________

(Signature of Witness/�� (Printed Name of Witness)

Date)

______________�� ____________

(Signature of Witness/�� (Printed Name of Witness)

Date)

ACCEPTANCE OF APPOINTMENT

AS REPRESENTATIVE

�� I accept this appointment and agree to serve as representative to make mental health treatment decisions. I understand that I must act consistently with the desires of the person I represent, as expressed in this declaration or, if not expressed, as otherwise known by me. If I do not know the desires of the person I represent, I have a duty to act in what I believe in good faith to be that person�s best interest. I understand that this document gives me authority to make decisions about mental health treatment only while that person has been determined to be incapable of making those decisions by a court or two capacity evaluators. I understand that the person who appointed me may revoke this declaration in whole or in part by communicating the revocation to the attending physician or other provider when the person is not incapable.

______________�� ____________

(Signature of�� (Printed name)

Representative/Date)

______________�� ____________

(Signature of Alternate�� (Printed name)

Representative/Date)

NOTICE TO PERSON

MAKING A DECLARATION FOR

MENTAL HEALTH TREATMENT

�� This is an important legal document. It creates a declaration for mental health treatment. Before signing this document, you should know these important facts:

�� This document allows you to make decisions in advance about certain types of mental health treatment: psychoactive medication, short-term (not to exceed the number of days you indicate above) admission to a treatment facility, convulsive treatment and outpatient services. Outpatient services are mental health services provided by appointment by licensed professionals and programs. The instructions that you include in this declaration will be followed only if a court or two capacity evaluators believe that you are incapable of making treatment decisions. Otherwise, you will be considered capable to give or withhold consent for the treatments. Your instructions may be overridden if you are being held pursuant to a court order.

�� You may also appoint a person as your representative to make treatment decisions for you if you become incapable. The person you appoint has a duty to act consistently with your desires as stated in this document or, if not stated, as otherwise known by the representative. If your representative does not know your desires, he or she must make decisions in your best interests. For the appointment to be effective, the person you appoint must accept the appointment in writing. The person also has the right to withdraw from acting as your representative at any time. A �representative� is also referred to as an �attorney-in-fact� in state law but this person does not need to be an attorney at law.

�� This document will continue in effect for a period of three years unless you become incapable of participating in mental health treatment decisions. If this occurs, the directive will continue in effect until you are no longer incapable.

�� You have the right to revoke this document in whole or in part at any time you have not been determined to be incapable. YOU MAY NOT REVOKE THIS DECLARATION WHEN YOU ARE CONSIDERED INCAPABLE BY A COURT OR TWO CAPACITY EVALUATORS. A revocation is effective when it is communicated to your attending physician or other provider.

�� If there is anything in this document that you do not understand, you should ask a lawyer to explain it to you. This declaration will not be valid unless it is signed by a notary or two qualified witnesses who are personally known to you and who are present when you sign or acknowledge your signature.

NOTICE TO PHYSICIAN OR PROVIDER

�� Under Oregon law, a person may use this declaration to provide consent for mental health treatment or to appoint a representative to make mental health treatment decisions when the person is incapable of making those decisions. A person is �incapable� when, in the opinion of a court or two capacity evaluators, the person�s ability to receive and evaluate information effectively or communicate decisions is impaired to such an extent that the person currently lacks the capacity to make mental health treatment decisions. This document becomes operative when it is delivered to the person�s physician or other provider and remains valid until revoked or expired. Upon being presented with this declaration, a physician or provider must make it a part of the person�s medical record. When acting under authority of the declaration, a physician or provider must comply with it to the fullest extent possible. If the physician or provider is unwilling to comply with the declaration, the physician or provider may withdraw from providing treatment consistent with professional judgment and must promptly notify the person and the person�s representative and document the notification in the person�s medical record. A physician or provider who administers or does not administer mental health treatment according to and in good faith reliance upon the validity of this declaration is not subject to criminal prosecution, civil liability or professional disciplinary action resulting from a subsequent finding of the declaration�s invalidity.

______________________________________________________________________________ [1997 c.563 �3 (enacted in lieu of 127.735); 2023 c.11 �4; 2025 c.559 �17]

�� 127.737 Certain other laws applicable to declaration. ORS 127.525, 127.550, 127.565, 127.570, 127.575 and