Patient Guide
ATTENTION: If you think you are experiencing COVID-19 symptoms, call our COVID-19 triage line at 503-814-0099 before entering a Salem Health Hospitals and Clinics facility. This includes staff. Anyone at a Salem Health facility (inside or outside) must wear a facial mask at all times.
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Advance directive

It’s your right to make your own health care decisions, even when you can’t speak for yourself. You can do this by filling out a legal document called an advance directive. If you already have one, bring it with you to the hospital and we can make a copy for your medical record. Or you may mail or fax it to our Health Information Management (HIM) team at:

Salem Health
Building B
Attn: HIM
PO Box 14001
Salem, OR 97309

Fax: 503-814-2728

For questions, please email HIM at

If you don’t have an advance directive, you may consider this an opportune time to create one – before you need it. Please click this link if you would like to download the form.

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.

If you have additional questions, please contact the Salem Health Spiritual Care Department at 503-561-5562.

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