Wisconsin Medical Power of Attorney Form [PDF]

A Wisconsin medical power of attorney, or a healthcare power of attorney, is a legal document that allows the person called the agent or attorney-in-fact to represent another party called the principal and make healthcare decisions on their behalf.

The medical power of attorney form includes a list of life-sustaining treatments that the principal would like to be subjected to in case they become incapacitated or, in some other way, unable to communicate their healthcare preferences directly to the healthcare provider.

The document can also include the principal’s preferences in terms of medication they want or don’t want to receive, as well as their preferences on artificial nutrition and hydration.

Laws and Legal Requirements for a Medical Power of Attorney in Wisconsin

Chapter 155 of the Wisconsin Statutes regulates the status of medical power of attorney in Wisconsin.

The principal must sign the medical power of attorney in front of at least two witnesses, according to Section 155.10(1)(c).

To revoke the medical power of attorney, you can issue a medical power of attorney revocation, destroy a previous document, issue a new one, or verbally revoke the document.

How to Write a Medical Power of Attorney in Wisconsin

Here, you can see the step-by-step process of drafting the Wisconsin medical power of attorney using our medical power of attorney template.

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

Here, you can find the medical power of attorney template. All you have to do is fill it out according to the instructions provided by our advanced legal document builder.

First, you should enter the basic details, such as the date of issuing the medical power of attorney, as well as the full name, address, and contact details of the principal.

#2. Appoint a Healthcare Representative

Here, you should enter the full name, mailing address, and contact details of the person you want to appoint as your healthcare representative.

The healthcare representative is also called the agent or the attorney-in-fact. The healthcare representative should be an adult and have the legal capacity to act.

Moreover, you should choose someone you can trust, considering that they will have the authority to make important decisions about your healthcare. You can appoint your spouse, a relative, a friend, or another trusted individual as your healthcare representative.

Here, you can also include the medical power of attorney rights and limitations and define your principal’s scope of authority.

#3. Identify an Alternative Healthcare Representative

An alternative healthcare representative is a person who acts in case the primary healthcare representative is unable to represent you.

That can happen when the primary healthcare representative loses their legal capacity, passes away, or is located far away from the place where they should represent you.

The alternative healthcare representative is also referred to as the alternative agent, secondary agent, or secondary attorney-in-fact. The alternative healthcare representative should fulfill the same requirements as the primary agent.

#4. Identify the Witnesses and Have Them Sign the Form

After finalizing your document, you should print and sign it. The principal and at least two witnesses who are both at least 18 years old must sign the medical power of attorney for it to be valid and effective.

The witness cannot be a person who:

Is connected to the principal by blood, marriage, or adoption
Knows that they are entitled or have a claim to any part of the principal’s estate
Directly financially responsible for the principal's health care
Principal’s healthcare provider
Principal’s agent

#5. Notarize the Form

Although it is not necessary by state law, it is always advisable to have the notary public acknowledge the medical power of attorney. This will additionally confirm the authenticity of the document and prevent fraud.