consent of supporter
I know .... (name of person) personally or I have received proof of his or her identity and I believe him or her to be at least 18 years of age and entering this agreement knowingly and voluntarily. I am at least 18 years of age.
I, .... (name of supporter), consent to act as a supporter under this agreement.
Supporter:
(print) Name ....
Address ....
E-mail address ....
Phone number(s) ....
Signature ....
Date ....
Statement AND SIGNATURE
OF WITNESSES OR
SIGNATURE OF NOTARY
(This agreement must be signed either by 2 witnesses who are at least 18 years of age or by a notary public.)
OPTION I: WITNESSES
I know .... (name of person) personally or I have received proof of his or her identity and I believe him or her to be at least 18 years of age and entering this agreement knowingly and voluntarily. I am at least 18 years of age.
Witness No. 1:
(print) Name ....
Address ....
Phone number(s) ....
Signature ....
Date ....
Witness No. 2:
(print) Name ....
Address ....
Phone number(s) ....
Signature ....
Date ....
OPTION II: NOTARY PUBLIC
State of ....
County of ....
This document was acknowledged before me on .... (date), by .... (name of adult with a functional impairment) and ..... (name of supporter).
Signature of notary ....
(Seal, if any, of notary)
Printed name ....
My commission expires: ....
(2) The department of health services shall prepare and provide access to a supported decision-making agreement instrument and accompanying information for adults with functional impairments, family members of adults with functional impairments, education professionals and school districts, health care and social service professionals, county clerks, and local bar associations. The department may charge a reasonable fee for the cost of preparation and distribution.
Subchapter III
duty of certain persons
with respect to agreement
53.30 Reliance on agreement; limitation of liability. (1) A person who receives the original or a copy of a supported decision-making agreement shall rely on the agreement, except if the person has cause to believe that the adult with a functional impairment is being abused, neglected, unduly influenced, or financially exploited by the supporter as described under s. 53.32.
(2) A person is not subject to criminal or civil liability and has not engaged in professional misconduct for an act or omission if the act or omission is done in good faith and in reliance on a supported decision-making agreement.
(3) Any health care provider that respects and acts consistently with the authority given to a supporter by a duly executed supported decision-making agreement shall be immune from any action alleging that the agreement was invalid unless the entity, custodian, or organization had actual knowledge or notice that the adult with a functional impairment had revoked such authorization, that the agreement was invalid, or that the supporter had committed abuse, neglect, or financial exploitation as described in s. 53.14 (2) (a).
(4) Any health care provider that provides health care based on the consent of an adult with a functional impairment, made with supports and services provided through a duly executed supported decision-making agreement, shall be immune from any action alleging that the adult with a functional impairment lacked capacity to provide informed consent unless the entity, custodian, or organization had actual knowledge or notice that the adult with a functional impairment had revoked such authorization, that the agreement was invalid, or that the supporter had committed abuse, neglect, or financial exploitation as described in s. 53.14 (2) (a).
(5) Any public or private entity, custodian, or organization that discloses personal information about an adult with a functional impairment to a supporter who is authorized to access, collect, or obtain or assist the adult with a functional impairment in accessing, collecting, or obtaining that information shall be immune from any action alleging that it improperly or unlawfully disclosed such information to the supporter unless the entity, custodian, or organization had actual knowledge that the adult with a functional impairment had revoked such authorization.
(6) This section may not be construed to provide immunity from actions alleging that a health care provider has done any of the following:
(a) Caused personal injury as a result of a negligent, reckless, or intentional act.
(b) Acted inconsistently with the expressed wishes of an adult with a functional impairment.
(c) Failed to provide information to either an adult with a functional impairment or his or her supporter that would be necessary for informed consent.
(d) Otherwise acted inconsistently with applicable law.
(7) The existence or availability of a supported decision-making agreement does not relieve a health care provider of any legal obligation to provide services to individuals with disabilities, including the obligation to provide reasonable accommodations or auxiliary aids and services, including interpretation services and communication supports to individuals with disabilities under the federal Americans with Disabilities Act.
(8) A supporter acting in the context of a valid supported decision-making agreement is immune from civil liability for his or her acts or omissions in performing duties as the supporter if he or she performs the duties in good faith, in conformance with the supported decision-making agreement or document of the adult with a functional impairment, and with the degree and prudence that an ordinarily prudent person exercises in his or her own affairs.
53.32 Reporting of suspected abuse, neglect, or financial exploitation. (1) If a person who receives a copy of a supported decision-making agreement or is aware of the existence of a supported decision-making agreement has cause to believe that the adult with a functional impairment is being abused, neglected, or financially exploited by the supporter, the person may report under s. 46.90 or 55.043 the alleged abuse, neglect, or financial exploitation.
(2) Nothing in this section may be construed as eliminating or limiting a person's requirement to report under any other statute or regulation.
345,2
Section
2. 54.10 (2) (b) 9m. of the statutes is created to read:
54.10 (2) (b) 9m. Whether any alternatives to guardianship, including supported decision-making under ch. 53, have been attempted, and, if applicable, the degree to which they have been attempted, the length of time they have been attempted, and whether they have been attempted in a manner sufficient to demonstrate that alternatives to guardianship are insufficient to enable the individual to adequately exercise the right or rights in question.
345,3
Section
3. 54.10 (3) (a) 4. of the statutes is amended to read:
54.10 (3) (a) 4. The individual's need for assistance in decision making or communication is unable to be met effectively and less restrictively through appropriate and reasonably available training, education, support services, health care, assistive devices, a supported decision-making agreement under ch. 53, or other means that the individual will accept.
345,4
Section
4. 54.10 (3) (b) of the statutes is amended to read:
54.10 (3) (b) Unless the proposed ward is unable to communicate decisions effectively in any way, the determination under par. (a) may not be based on mere old age, eccentricity, poor judgment, or physical disability
, or the existence of a supported decision-making agreement.
345,5
Section
5. 115.807 (4) of the statutes is created to read:
115.807 (4) The local educational agency shall provide the individual and the individual's parents with information on supported decision-making under ch. 53, other alternatives to guardianship, and strategies to remain engaged in the individual's secondary education.
