SB488,3,1413 (f) One member nominated by the Wisconsin Health and Hospital Association,
14Inc.
SB488,3,1515 (g) One member nominated by the Wisconsin Nurses Association, Inc.
SB488,4,1
1(h) One member nominated by the State Medical Society of Wisconsin.
SB488,4,22 (i) One member nominated by the State Bar of Wisconsin.
SB488, s. 2 3Section 2. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
4the following amounts for the purposes indicated: - See PDF for table PDF
SB488, s. 3 5Section 3. 20.435 (1) (bm) of the statutes is created to read:
SB488,4,96 20.435 (1) (bm) Wisconsin donor registry. As a continuing appropriation, the
7amounts in the schedule for permanent property, supplies, services and staff support
8for the establishment, operation, maintenance and monitoring of the Wisconsin
9donor registry.
SB488, s. 4 10Section 4. 20.435 (1) (bm) of the statutes, as created by 1999 Wisconsin Act
11.... (this act), is amended to read:
SB488,4,1512 20.435 (1) (bm) Wisconsin donor registry. As a continuing appropriation, the
13amounts in the schedule for permanent property, supplies, services and staff support
14for the establishment, operation, maintenance and monitoring of the Wisconsin
15donor registry.
SB488, s. 5 16Section 5. 146.71 of the statutes is amended to read:
SB488,5,5 17146.71 Determination of death. An individual who has sustained either
18irreversible cessation of circulatory and respiratory functions or irreversible

1cessation of all functions of the entire brain, including the brain stem, is dead. A
2determination of death shall be made in accordance with accepted medical
3standards. A physician who acts in accordance with this section in making a
4determination of death or attempts in good faith to do so is not liable for that act in
5a civil action or criminal proceeding.
SB488, s. 6 6Section 6. 155.30 (3) of the statutes is amended to read:
SB488,5,207 155.30 (3) The department shall prepare and provide copies of a power of
8attorney for health care instrument and accompanying information for distribution
9in quantities to health care professionals, hospitals, nursing homes, multipurpose
10senior centers, county clerks and local bar associations and individually to private
11persons. The department shall include, in information accompanying the copy of the
12instrument, at least the statutory definitions of terms used in the instrument,
13statutory restrictions on who may be witnesses to a valid instrument, a statement
14explaining that valid witnesses acting in good faith are statutorily immune from civil
15or criminal liability and a statement explaining that an instrument may, but need
16not, be filed with the register in probate of the principal's county of residence. The
17department may charge a reasonable fee for the cost of preparation and distribution.
18The power of attorney for health care instrument distributed by the department
19shall include the notice specified in sub. (1) and shall, except as provided in sub. (3m),
20be in the following form:
SB488,5,2121 POWER OF ATTORNEY
SB488,5,2222 FOR HEALTH CARE
SB488,5,2323 Document made this.... day of.... (month),.... (year).
SB488,5,2424 CREATION OF POWER OF
SB488,5,2525 ATTORNEY FOR HEALTH CARE
SB488,6,8
1I,.... (print name, address and date of birth), being of sound mind, intend by this
2document to create a power of attorney for health care. My executing this power of
3attorney for health care is voluntary. Despite the creation of this power of attorney
4for health care, I expect to be fully informed about and allowed to participate in any
5health care decision for me, to the extent that I am able. For the purposes of this
6document, "health care decision" means an informed decision to accept, maintain,
7discontinue or refuse any care, treatment, service or procedure to maintain, diagnose
8or treat my physical or mental condition.
SB488,6,109 In addition, I may, by this document, specify my wishes with respect to making
10an anatomical gift upon my death.
SB488,6,1111 DESIGNATION OF HEALTH CARE AGENT
SB488,7,212 If I am no longer able to make health care decisions for myself, due to my
13incapacity, I hereby designate.... (print name, address and telephone number) to be
14my health care agent for the purpose of making health care decisions on my behalf.
15If he or she is ever unable or unwilling to do so, I hereby designate.... (print name,
16address and telephone number) to be my alternate health care agent for the purpose
17of making health care decisions on my behalf. Neither my health care agent nor my
18alternate health care agent whom I have designated is my health care provider, an
19employe of my health care provider, an employe of a health care facility in which I
20am a patient or a spouse of any of those persons, unless he or she is also my relative.
21For purposes of this document, "incapacity" exists if 2 physicians or a physician and
22a psychologist who have personally examined me sign a statement that specifically
23expresses their opinion that I have a condition that means that I am unable to receive
24and evaluate information effectively or to communicate decisions to such an extent

1that I lack the capacity to manage my health care decisions. A copy of that statement
2must be attached to this document.
SB488,7,33 GENERAL STATEMENT OF
SB488,7,44 AUTHORITY GRANTED
SB488,7,115 Unless I have specified otherwise in this document, if I ever have incapacity I
6instruct my health care provider to obtain the health care decision of my health care
7agent, if I need treatment, for all of my health care and treatment. I have discussed
8my desires thoroughly with my health care agent and believe that he or she
9understands my philosophy regarding the health care decisions I would make if I
10were able. I desire that my wishes be carried out through the authority given to my
11health care agent under this document.
SB488,7,2012 If I am unable, due to my incapacity, to make a health care decision, my health
13care agent is instructed to make the health care decision for me, but my health care
14agent should try to discuss with me any specific proposed health care if I am able to
15communicate in any manner, including by blinking my eyes. If this communication
16cannot be made, my health care agent shall base his or her decision on any health
17care choices that I have expressed prior to the time of the decision. If I have not
18expressed a health care choice about the health care in question and communication
19cannot be made, my health care agent shall base his or her health care decision on
20what he or she believes to be in my best interest.
SB488,7,2121 LIMITATIONS ON
SB488,7,2222 MENTAL HEALTH TREATMENT
SB488,8,223 My health care agent may not admit or commit me on an inpatient basis to an
24institution for mental diseases, an intermediate care facility for the mentally
25retarded, a state treatment facility or a treatment facility. My health care agent may

1not consent to experimental mental health research or psychosurgery,
2electroconvulsive treatment or drastic mental health treatment procedures for me.
SB488,8,43 ADMISSION TO NURSING HOMES
4 OR COMMUNITY-BASED RESIDENTIAL FACILITIES
SB488,8,65 My health care agent may admit me to a nursing home or community-based
6residential facility for short-term stays for recuperative care or respite care.
SB488,8,97 If I have checked "Yes" to the following, my health care agent may admit me for
8a purpose other than recuperative care or respite care, but if I have checked "No" to
9the following, my health care agent may not so admit me:
SB488,8,1010 1. A nursing home — Yes.... No....
SB488,8,1111 2. A community-based residential facility — Yes.... No....
SB488,8,1312 If I have not checked either "Yes" or "No" immediately above, my health care
13agent may admit me only for short-term stays for recuperative care or respite care.
SB488,8,1414 PROVISION OF A FEEDING TUBE
SB488,8,1915 If I have checked "Yes" to the following, my health care agent may have a
16feeding tube withheld or withdrawn from me, unless my physician has advised that,
17in his or her professional judgment, this will cause me pain or will reduce my comfort.
18If I have checked "No" to the following, my health care agent may not have a feeding
19tube withheld or withdrawn from me.
SB488,8,2220 My health care agent may not have orally ingested nutrition or hydration
21withheld or withdrawn from me unless provision of the nutrition or hydration is
22medically contraindicated.
SB488,8,2323 Withhold or withdraw a feeding tube — Yes.... No....
SB488,8,2524 If I have not checked either "Yes" or "No" immediately above, my health care
25agent may not have a feeding tube withdrawn from me.
SB488,9,1
1HEALTH CARE DECISIONS
SB488,9,22 FOR PREGNANT WOMEN
SB488,9,63 If I have checked "Yes" to the following, my health care agent may make health
4care decisions for me even if my agent knows I am pregnant. If I have checked "No"
5to the following, my health care agent may not make health care decisions for me if
6my health care agent knows I am pregnant.
SB488,9,77 Health care decision if I am pregnant — Yes.... No....
SB488,9,108 If I have not checked either "Yes" or "No" immediately above, my health care
9agent may not make health care decisions for me if my health care agent knows I am
10pregnant.
SB488,9,1111 STATEMENT OF DESIRES, SPECIAL
SB488,9,1212 PROVISIONS OR LIMITATIONS
SB488,9,1613 In exercising authority under this document, my health care agent shall act
14consistently with my following stated desires, if any, and is subject to any special
15provisions or limitations that I specify. The following are specific desires, provisions
16or limitations that I wish to state (add more items if needed):
SB488,9,1717 1) -
SB488,9,1818 2) -
SB488,9,1919 3) -
SB488,9,2020 INSPECTION AND DISCLOSURE OF INFORMATION
SB488,9,2121 RELATING TO MY PHYSICAL OR MENTAL HEALTH
SB488,9,2322 Subject to any limitations in this document, my health care agent has the
23authority to do all of the following:
SB488,9,2524 (a) Request, review and receive any information, oral or written, regarding my
25physical or mental health, including medical and hospital records.
SB488,10,2
1(b) Execute on my behalf any documents that may be required in order to obtain
2this information.
SB488,10,33 (c) Consent to the disclosure of this information.
SB488,10,44 (The principal and the witnesses all must sign the document at the same time.)
SB488,10,55 SIGNATURE OF PRINCIPAL
SB488,10,66 (person creating the power
SB488,10,77 of attorney for health care)
SB488,10,88 Signature.... Date....
SB488,10,109 (The signing of this document by the principal revokes all previous powers of
10attorney for health care documents.)
SB488,10,1111 STATEMENT OF WITNESSES
SB488,10,2112 I know the principal personally and I believe him or her to be of sound mind and
13at least 18 years of age. I believe that his or her execution of this power of attorney
14for health care is voluntary. I am at least 18 years of age, am not related to the
15principal by blood, marriage or adoption and am not directly financially responsible
16for the principal's health care. I am not a health care provider who is serving the
17principal at this time, an employe of the health care provider, other than a chaplain
18or a social worker, or an employe, other than a chaplain or a social worker, of an
19inpatient health care facility in which the declarant is a patient. I am not the
20principal's health care agent. To the best of my knowledge, I am not entitled to and
21do not have a claim on the principal's estate.
SB488,10,2222 Witness No. 1:
SB488,10,2323 (print) Name.... Date....
SB488,10,2424 Address....
SB488,10,2525 Signature....
SB488,11,1
1Witness No. 2:
SB488,11,22 (print) Name.... Date....
SB488,11,33 Address....
SB488,11,44 Signature....
SB488,11,55 STATEMENT OF HEALTH CARE AGENT
SB488,11,66 AND ALTERNATE HEALTH CARE AGENT
SB488,11,107 I understand that.... (name of principal) has designated me to be his or her
8health care agent or alternate health care agent if he or she is ever found to have
9incapacity and unable to make health care decisions himself or herself. .... (name of
10principal) has discussed his or her desires regarding health care decisions with me.
SB488,11,1111 Agent's signature....
SB488,11,1212 Address....
SB488,11,1313 Alternate's signature....
SB488,11,1414 Address....
SB488,11,1715 Failure to execute a power of attorney for health care document under chapter
16155 of the Wisconsin Statutes creates no presumption about the intent of any
17individual with regard to his or her health care decisions.
SB488,11,1918 This power of attorney for health care is executed as provided in chapter 155
19of the Wisconsin Statutes.
SB488,11,2020 ANATOMICAL GIFTS (optional)
SB488,11,2121 Upon my death:
SB488,11,2322 .... I wish to donate only the following organs or parts: .... (specify the organs or
23parts).
SB488,11,2424 .... I wish to donate any needed organ or part.
SB488,12,4
1.... I wish to donate my body for anatomical study if needed. (Since many
2institutions have certain conditions that must be met before receiving donation of a
3body, I will attempt to contact the institution to which the donation is intended to be
4made.)
SB488,12,75 .... I refuse to make an anatomical gift. (If this revokes a prior commitment that
6I have made to make an anatomical gift to a designated donee, I will attempt to notify
7the donee to which or to whom I agreed to donate.)
SB488,12,98 Failing to check any of the lines immediately above creates no presumption
9about my desire to make or refuse to make an anatomical gift.
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