Advance directives and POLST
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:
PO Box 14001
Salem, OR 97309
For questions, please email HIM at HIMRecordIntegrity@salemhealth.org.
If you don’t have an advance directive, you may consider this an opportune time to create one – before you need it. Please click here 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.
What is a POLST?
POLST stands for Portable Orders for Life-Sustaining Treatment. It is a voluntary form that turns your wishes for treatment into a medical order. It is meant for people with a serious illness, such as advanced heart disease, advanced lung disease,
or cancer that has spread. It is also for people who are older and frail and might not want all medical treatments.
Salem Health recognizes the right of every adult patient or emancipated minor to participate in the development and implementation of their own plan of care, to request or refuse treatment including consenting to or refusing life-prolonging intervention,
and to receive adequate information so they can make an informed decision about their care. This policy is based on ethical, legal, and moral principles recognizing the importance of patient autonomy. A person who is incapacitated at the moment of
decision has the right to have their wishes respected. The POLST form is one of the legally recognized vehicles in the state of Oregon for a person to convey their care wishes before a medical crisis occurs.If you have additional questions, please contact the Salem Health Spiritual Care Department at 503-561-5562.
You have the right to a support
person of your choosing to be present for any discussion in which you are asked to elect hospice care or to sign an advance directive, POLST form, or other document allowing the withholding or withdrawing of life-sustaining procedures or artificially
administered nutrition or hydration. You also have the right to have such discussions outside of the presence of a support person.