Address....
Signature....
STATEMENT OF HEALTH CARE AGENT AND
ALTERNATE HEALTH CARE AGENT
I understand that.... (name of principal) has designated me to be his or her health care agent or alternate health care agent if he or she is ever found to have incapacity and unable to make health care decisions himself or herself. .... (name of principal) has discussed his or her desires regarding health care decisions with me.
Agent's signature....
Address....
Alternate's signature....
Address....
Failure to execute a power of attorney for health care document under chapter 155 of the Wisconsin Statutes creates no presumption about the intent of any individual with regard to his or her health care decisions.
This power of attorney for health care is executed as provided in chapter 155 of the Wisconsin Statutes.
ANATOMICAL GIFTS (optional)
Upon my death:
.... I wish to donate only the following organs or parts: .... (specify the organs or parts).
.... I wish to donate any needed organ or part.
.... I wish to donate my body for anatomical study if needed.
.... I refuse to make an anatomical gift. (If this revokes a prior commitment that I have made to make an anatomical gift to a designated donee, I will attempt to notify the donee to which or to whom I agreed to donate.)
Failing to check any of the lines immediately above creates no presumption about my desire to make or refuse to make an anatomical gift.
Signature.... Date....
90,31
Section
31. 155.50 (1) (b) of the statutes is amended to read:
155.50 (1) (b) Failing to comply with a power of attorney for health care instrument or the decision of a health care agent, except that failure of a physician health care professional, as defined in s. 154.01 (3), to comply constitutes unprofessional conduct if the physician health care professional refuses or fails to make a good faith attempt to transfer the principal to another physician health care professional who will comply.
90,32
Section
32. 165.77 (1) (a) of the statutes is amended to read:
165.77 (1) (a) “Health care professional"
has the meaning given in s. 154.01 (3) means a person licensed, certified, or registered under ch. 441, 448, or 455.
90,33
Section
33. 302.384 of the statutes is renumbered 302.384 (2m), and 302.384 (2m) (a), as renumbered, is amended to read:
302.384 (2m) (a) A sheriff, jailer, keeper or officer arranges for a health care professional, as defined in s. 154.01 (3), to observe the prisoner.
90,34
Section
34. 302.384 (1m) of the statutes is created to read:
302.384 (1m) In this section, “health care professional” means a person licensed, certified, or registered under ch. 441, 448, or 455.
90,35
Section
35. 441.07 (1g) (d) (intro.) of the statutes is amended to read:
441.07 (1g) (d) (intro.) Misconduct or unprofessional conduct. In this paragraph, “unprofessional conduct” includes making a determination under ch. 154 or 155 if the person does not have sufficient education, training, and experience to make the determination. In this paragraph, “misconduct" and “unprofessional conduct" do not include any of the following:
90,36
Section
36. 448.015 (4) (am) 2m. of the statutes is created to read:
448.015 (4) (am) 2m. A determination made by a physician assistant under ch. 154 or 155 if the physician assistant does not have sufficient education, training, and experience to make the determination.
