Important Documents

We always want to make sure you understand your rights and responsibilities as a patient. Please see our statement regarding Oregon Law ORS 441.098

YOU HAVE A CHOICE


Below are several documents that may assist us in understanding your needs and providing you with the best medical care.

Please review and complete the appropriate forms prior to your visit. If you have questions about any of the information below, please feel free to call our office at 503-595-9300.



Pre-Visit Checklist

Please look through this checklist prior to your appointment and remember to bring your insurance card and photo ID. 

PRE-VISIT CHECKLIST


Medical Records Requests

To have your records sent to the Sellwood Clinic from a previous provider, complete and sign this form and send it to your previous provider.

MEDICAL RELEASE TO US

To have your records sent from our office to another provider, complete and sign this form and fax or send it to us at Sellwood Medical Clinic, P.C.

MEDICAL RELEASE FROM US


Optional Legal Documents

What kind of medical care would you want if you were too ill or injured to express your wishes? The forms below are legal documents allowing you to convey your decisions to family, friends and health care professionals. Whatever your age or the current state of your health, these forms can protect you and your loved ones and ensure that your wishes are followed in the event you are unable to express them yourself.

An advance directive documents your preferences regarding care intended to sustain life. It allows you to appoint a health care representative (a proxy) to make health care decisions for you if you are unable to do so.

The advance directive form below can be completed at any time. This document should be legally authorized.

ADVANCE DIRECTIVE FORM

The POLST (Physician Orders for Life-Sustaining Treatment) form states a patient's preferences for treatment toward the end of their lives. This form should be completed each year when you are well and can fully make determinations about what kind of end-of-life medical care you desire.

POLST FORM

If you would like your provider to have either of these documents on file, please print and complete them at home and bring them to your next appointment or mail them to us.

More information about the advance directive or POLST forms is available here.

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