The Wisconsin Advance Directive implements an order permitting a designated person to make medical decisions for another if they are unable to make the choices due to being incapacitated. The contract is a common formality instituted to prepare should a serious health problem occur, rendering an individual incapable. In these cases, a selected agent can be identified and predetermined to move forward on behalf of the principal party legally. The form expresses the extent of granted controls and presents a systemized format allowing the principal to choose which powers to extend and how they would like their preferences to be carried out by the indicated agent. Once the declarant completes the paperwork, it is required to be endorsed with the aid of two (2) witnessing individuals to corroborate the occurrence.
Laws
Statute – Wisconsin Statutes § 154-01 – 154-30
Definitions – § 154-01 – 154-02
Signing Requirements – The document must be signed before two (2) viable witnesses to validate the declaration. State law additionally stipulates the following regarding witness acceptability:
“No witness to the execution of the declaration may, at the time of the execution, be any of the following:
(a) Related to the declarant by blood, marriage or adoption.
(b) Have knowledge that he or she is entitled to or has a claim on any portion of the declarant’s estate.
(c) Directly financially responsible for the declarant’s health care.
(d) An individual who is a health care provider, as defined in §155-01(7), who is serving the declarant at the time of execution, an employee, other than a chaplain or a social worker, of the health care provider or an employee, other than a chaplain or a social worker, of an inpatient health care facility in which the declarant is a patient.” (§ 154-03(1))
Other Versions (5)
- AARP (Caring Connections)
- Ascension Wisconsin
- Aurora Health Care
- Five Wishes (Aging with Dignity)
- Prepare for Your Care
AARP (Caring Connections) Version
Download: Adobe PDF
Instructions: Adobe PDF
Ascension Wisconsin Advance Directive Form
Download: Adobe PDF
Aurora Health Care Advance Directive Form (also available in Spanish/en Español)
Download: Adobe PDF
Large Print Version: Adobe PDF
Five Wishes (Aging with Dignity) Version
Download: Adobe PDF
Information: Adobe PDF
Prepare for Your Care Version (also available in Spanish/en Español)
Download: Adobe PDF
Additional Resources
- Aurora Health Care – Advance Care Planning Guide
- Froedtert & Medical College of Wisconsin – Making an Advance Directive
- State Bar of Wisconsin – Health Care: Answering your Legal Questions
- University of Wisconsin – Advance Directives for Health Care
- U.S. Department of Health and Human Services – Your Rights under HIPAA
- Wisconsin Department of Health Services – End of Life Planning
- Wisconsin Department of Health Services – Do-Not-Resuscitate (DNR) Information
- Wisconsin Department of Health Services – Wisconsin Consumer’s Guide to Health Information Privacy
Related Forms (5)
- Advance Directive Wallet Card
- Document of Anatomical Gift
- Durable (Financial) Power of Attorney Form
- DNR (Do-Not-Resuscitate) Order
- HIPAA Release Authority
Download: Adobe PDF
Document of Anatomical Gift – Authorization for Organ and Tissue Donation Form F-43025 (also available in Spanish/en Español)
Download: Adobe PDF
Durable (Financial) Power of Attorney
Download: Adobe PDF
Emergency Care Do Not Resuscitate Order (DNR) Form F-44763
Download: Adobe PDF
Health Care Power of Attorney Addendum – HIPAA Release Authority
Download: Adobe PDF
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