The Wisconsin Medical Power of Attorney prepares a legal reference to entitle an alternate individual to make health care decisions in place of oneself should it be required due to incapacitation. The document allows for certified recording of additional predetermined requests by a signing principal. A designated agent’s appointment is confirmed, along with an outline of the exact operations to be taken for indicated circumstances. Specification on the course of action to take is refined concerning nursing home admittance and feeding tube options. Allocated space to submit a preference for limitation of controls of the designated attorney-in-fact and special requests is provided within the contract for a comprehensive determination of the principal’s expectations. Endorsement of the paperwork can occur with the accompaniment of two (2) authorized witnesses per Wisconsin Statutes § 155-10(2).
Laws
Statute – Power of Attorney for Health Care § 155-02 – 155-80
Definition – “Power of attorney for health care” means the designation, by an individual, of another as his or her health care agent for the purpose of making health care decisions on his or her behalf if the individual cannot, due to incapacity (§ 155-01(10)).
Signing Requirements – To validate the document’s execution, it is mandated that two (2) witnesses view the endorsement of the contract. The witnesses must meet the requirements outlined in the guidelines put forth in the Wisconsin Statutes § 155-10(2).
Other Versions (3)
Agnesian Power of Attorney for Health Care Version
Download: Adobe PDF
Mayo Clinic Wisconsin Power of Attorney for Health Care Version
Download: Adobe PDF
Pro Life Protective Power of Attorney for Health Care Version
Download: Adobe PDF
Multilingual Versions (3)
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Additional Resources
- American Bar Association – Giving Someone a Power of Attorney for Your Health Care
- Employment Resources Inc. of Wisconsin – It’s the Law: Guardianships, Powers of Attorney, Representative Payees
- Prevea Health – Facing Difficult Decisions at the End of Life
- Pro Life Wisconsin – Answers Your Questions About the Wisconsin Protective Power of Attorney for Health Care
- State Bar of Wisconsin – Health Care: Answering your Legal Questions
- Wisconsin Department of Health Services – End of Life Planning
Related Forms (8)
- Advance Directive (Medical POA & Living Will)
- Advance Directive Wallet Card
- Authorization for Final Disposition
- Document of Anatomical Gift
- Durable (Financial) Power of Attorney Form
- DNR (Do-Not-Resuscitate) Order
- GWAAR Revocation of Power of Attorney For Health Care
- HIPAA Release Authority
Advance Directive (Medical POA & Living Will)
Download: Adobe PDF
Download: Adobe PDF
Authorization for Final Disposition Form F-00086
Download: Adobe PDF
Durable (Financial) Power of Attorney
Download: Adobe PDF
Document of Anatomical Gift – Authorization for Organ and Tissue Donation Form F-43025
Download: Adobe PDF
Emergency Care Do Not Resuscitate Order (DNR) Form F-44763
Download: Adobe PDF
Greater Wisconsin Agency on Aging Resources Revocation of Power of Attorney For Health Care
Download: Adobe PDF
Health Care Power of Attorney Addendum – HIPAA Release Authority
Download: Adobe PDF