Attorney-Approved Wisconsin Medical Power of Attorney Document
The Wisconsin Medical Power of Attorney form is an essential document that empowers individuals to designate a trusted person to make healthcare decisions on their behalf when they are unable to do so. This form ensures that a person's medical preferences are honored, even if they cannot communicate them directly. It allows individuals to choose an agent who understands their values and wishes regarding medical treatment. The form outlines the authority granted to the agent, which can include decisions about life-sustaining treatments, surgeries, and other medical interventions. Additionally, it is important to note that the form must be signed and dated in the presence of witnesses to be valid. By completing this document, individuals can take proactive steps to ensure their healthcare choices are respected, providing peace of mind for themselves and their loved ones during challenging times.
Form Example
Wisconsin Medical Power of Attorney
This Wisconsin Medical Power of Attorney is a legally binding document that allows an individual (the "Principal") to designate another person (the "Agent") to make health care decisions on their behalf in the event that they are unable to do so. This document is crafted in accordance with the Wisconsin Statutes, specifically the chapter that governs powers of attorney for health care decisions.
Principal Information
- Full Name: ___________________________
- Address: ______________________________
- City: _________________________________
- State: Wisconsin
- Zip Code: ____________________________
- Phone Number: ________________________
Agent Information
- Full Name: ___________________________
- Address: ______________________________
- City: _________________________________
- State: __________________________________
- Zip Code: ____________________________
- Phone Number: ________________________
- Alternate Phone Number: ________________
Successor Agent Information (Optional)
- Full Name: ___________________________
- Address: ______________________________
- City: _________________________________
- State: __________________________________
- Zip Code: ____________________________
- Phone Number: ________________________
- Alternate Phone Number: ________________
This document grants the Agent the same authority as the Principal would possess concerning health care decisions, subject to any limitations specified in this document. The Agent's authority is effective immediately upon the Principal's incapacity, as determined by a physician. The Principal reserves the right to revoke this directive at any time.
Any decision made by the Agent on behalf of the Principal should be in the Principal's best interest and in accordance with any wishes the Principal has communicated. In the absence of specific instructions, the Agent is tasked with deciding based on what they believe the Principal would have wanted.
Special Instructions:
________________________________________________________________________________________________
________________________________________________________________________________________________
In witness whereof, the Principal has executed this Wisconsin Medical Power of Attorney on the date below:
Date: _________________________
Principal's Signature: _____________________________________
State of Wisconsin, County of ______________
This document was acknowledged before me on (Date) ______________ by (Name of Principal) ____________________________.
Notary Public: __________________________________
My Commission Expires: __________________________
Agent's Acceptance of Appointment
I, _______________________, hereby accept the appointment as Agent under the above Power of Attorney for Health Care. I understand my obligations under this document and the Wisconsin Statutes, and I agree to act in accordance with the best interests of the Principal to the best of my ability.
Date: _________________________
Agent's Signature: _____________________________________
File Specifications
| Fact Name | Description |
|---|---|
| Definition | The Wisconsin Medical Power of Attorney form allows individuals to designate someone to make healthcare decisions on their behalf if they become unable to do so. |
| Governing Law | This form is governed by Wisconsin Statutes Chapter 155, which outlines the laws regarding powers of attorney for healthcare. |
| Eligibility | Any adult resident of Wisconsin can create a Medical Power of Attorney, provided they are mentally competent at the time of signing. |
| Agent Selection | The individual can choose any competent adult as their agent, except for healthcare providers or employees of healthcare facilities where the individual is receiving care. |
| Signature Requirement | The form must be signed by the principal (the person creating the power of attorney) and witnessed by two adults or notarized. |
| Revocation | The principal can revoke the Medical Power of Attorney at any time, as long as they are mentally competent. |
| Durability | This power of attorney remains effective even if the principal becomes incapacitated, ensuring that the agent can make decisions when needed. |
| Healthcare Decisions | The agent can make a wide range of healthcare decisions, including consent to or refusal of medical treatment, based on the principal's wishes. |
Some Other Wisconsin Templates
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