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15.195
(2) Donor registry board. There is created a donor registry board,
3attached to the department of health and family services under s. 15.03. The donor
4registry board shall consist of the secretary of health and family services and the
5secretary of transportation, or their designees, as nonvoting members, and shall
6consist of the following voting members appointed for 3-year terms:
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(a) One representative of each of 2 organ procurement organizations.
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(b) Two representatives of repositories for donated human tissue and bone.
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(c) One representative of a repository for donated human eyes or portions of
10eyes.
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(d) One recipient of organ or tissue donation or his or her family member.
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(e) One organ or tissue donor or his or her family member.
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(f) One member nominated by the Wisconsin Health and Hospital Association,
14Inc.
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(g) One member nominated by the Wisconsin Nurses Association, Inc.
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1(h) One member nominated by the State Medical Society of Wisconsin.
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(i) One member nominated by the State Bar of Wisconsin.
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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 AB915, s. 3
5Section
3. 20.435 (1) (bm) of the statutes is created to read:
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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.
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10Section
4. 20.435 (1) (bm) of the statutes, as created by 1999 Wisconsin Act
11.... (this act), is amended to read:
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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.
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16Section
5. 146.71 of the statutes is amended to read:
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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.
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6Section
6. 155.30 (3) of the statutes is amended to read:
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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:
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POWER OF ATTORNEY
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FOR HEALTH CARE
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Document made this.... day of.... (month),.... (year).
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CREATION OF POWER OF
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ATTORNEY FOR HEALTH CARE
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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.
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In addition, I may, by this document, specify my wishes with respect to making
10an anatomical gift upon my death.
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DESIGNATION OF HEALTH CARE AGENT
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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.
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GENERAL STATEMENT OF
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AUTHORITY GRANTED
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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.
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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.
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LIMITATIONS ON
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MENTAL HEALTH TREATMENT
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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.
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ADMISSION TO NURSING HOMES
4
OR COMMUNITY-BASED RESIDENTIAL FACILITIES
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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.
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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:
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1. A nursing home — Yes.... No....
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2. A community-based residential facility — Yes.... No....
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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.
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PROVISION OF A FEEDING TUBE
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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.
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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.
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Withhold or withdraw a feeding tube — Yes.... No....
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If I have not checked either "Yes" or "No" immediately above, my health care
25agent may not have a feeding tube withdrawn from me.
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1HEALTH CARE DECISIONS
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FOR PREGNANT WOMEN
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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.
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Health care decision if I am pregnant — Yes.... No....
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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.
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STATEMENT OF DESIRES, SPECIAL
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PROVISIONS OR LIMITATIONS
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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):
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INSPECTION AND DISCLOSURE OF INFORMATION
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RELATING TO MY PHYSICAL OR MENTAL HEALTH
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Subject to any limitations in this document, my health care agent has the
23authority to do all of the following:
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(a) Request, review and receive any information, oral or written, regarding my
25physical or mental health, including medical and hospital records.
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1(b) Execute on my behalf any documents that may be required in order to obtain
2this information.
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(c) Consent to the disclosure of this information.
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(The principal and the witnesses all must sign the document at the same time.)
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SIGNATURE OF PRINCIPAL
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(person creating the power
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of attorney for health care)
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Signature.... Date....
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(The signing of this document by the principal revokes all previous powers of
10attorney for health care documents.)
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STATEMENT OF WITNESSES
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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.
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Witness No. 1:
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(print) Name.... Date....
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Address....
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Signature....
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1Witness No. 2:
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(print) Name.... Date....
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Signature....
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STATEMENT OF HEALTH CARE AGENT
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AND ALTERNATE HEALTH CARE AGENT
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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.
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Agent's signature....
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Address....
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Alternate's signature....
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Address....
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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.
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This power of attorney for health care is executed as provided in chapter 155
19of the Wisconsin Statutes.
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ANATOMICAL GIFTS (optional)