Oregon Health Emergency Protocol Form

Purpose:
The Oregon Health Emergency Protocol form is available for any patient whose medical or mental health condition(s) require specific non-standard treatment, or when there is a known best course of treatment, should they suffer a medical emergency related to that condition.

Usage:
The form may only be completed and signed by an authorized health care provider with a verifiable license.

Providers may encounter this form:

  • In the emergency department when a patient/caregiver provides a copy
  • In the electronic medical record
  • In the HERO Kids Registry (for patients 0-26)

The form is for emergency medical use only. It does not guarantee specific care, treatment, action, or hospital. Having this information supports more informed care.

one-page Oregon Health Emergency Protocol form