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Declaration for mental health treatment

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Oregon has a form called a Declaration for Mental Health Treatment. This form is a legal document. It allows you to make decisions now about future mental health care in case you are unable to make your own care decisions.

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You may also use this form to name an adult who can make mental health choices for you when you cannot make them for yourself.

This person must agree in writing to represent you. The person you name must follow your wishes. If no one knows your wishes, the person you name must make them for you. They must make decisions that are in your best interest.

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A Declaration of Mental Health Treatment is good for three (3) years. If you become unable to make decisions, this document will remain in effect until you are able to make your own decisions.

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You may change or cancel your Declaration at any time as long as you are capable of making decisions for yourself.

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It is important to give this form to your doctor and a copy to the person who represents you.  

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You may request this form by:

For more information on the Declaration for Mental Health Treatment, go to the State of Oregon’s website at: https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le9550.pdf

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