1. A nursing home — Yes.... No....
2. A community-based residential facility — Yes.... No....
If I have not checked either "Yes" or "No" immediately above, my health care agent may admit me only for short-term stays for recuperative care or respite care.
PROVISION OF A FEEDING TUBE
If I have checked "Yes" to the following, my health care agent may have a feeding tube withheld or withdrawn from me, unless my physician has advised that, in his or her professional judgment, this will cause me pain or will reduce my comfort. If I have checked "No" to the following, my health care agent may not have a feeding tube withheld or withdrawn from me.
My health care agent may not have orally ingested nutrition or hydration withheld or withdrawn from me unless provision of the nutrition or hydration is medically contraindicated.
Withhold or withdraw a feeding tube — Yes.... No....
If I have not checked either "Yes" or "No" immediately above, my health care agent may not have a feeding tube withdrawn from me.
HEALTH CARE DECISIONS FOR
PREGNANT WOMEN
If I have checked "Yes" to the following, my health care agent may make health care decisions for me even if my agent knows I am pregnant. If I have checked "No" to the following, my health care agent may not make health care decisions for me if my health care agent knows I am pregnant.
Health care decision if I am pregnant — Yes.... No....
If I have not checked either "Yes" or "No" immediately above, my health care agent may not make health care decisions for me if my health care agent knows I am pregnant.
STATEMENT OF DESIRES,
SPECIAL PROVISIONS OR LIMITATIONS
In exercising authority under this document, my health care agent shall act consistently with my following stated desires, if any, and is subject to any special provisions or limitations that I specify. The following are specific desires, provisions or limitations that I wish to state (add more items if needed):
1) -
2) -
3) -
INSPECTION AND DISCLOSURE OF
INFORMATION RELATING TO MY PHYSICAL
OR MENTAL HEALTH
Subject to any limitations in this document, my health care agent has the authority to do all of the following:
(a) Request, review and receive any information, oral or written, regarding my physical or mental health, including medical and hospital records.
(b) Execute on my behalf any documents that may be required in order to obtain this information.
(c) Consent to the disclosure of this information.
(The principal and the witnesses all must sign the document at the same time.)
SIGNATURE OF PRINCIPAL
(person creating the power of attorney for health care)
Signature.... Date....
(The signing of this document by the principal revokes all previous powers of attorney for health care documents.)
STATEMENT OF WITNESSES
I know the principal personally and I believe him or her to be of sound mind and at least 18 years of age. I believe that his or her execution of this power of attorney for health care is voluntary. I am at least 18 years of age, am not related to the principal by blood, marriage, or adoption, am not the domestic partner under ch. 770 of the principal, and am not directly financially responsible for the principal's health care. I am not a health care provider who is serving the principal at this time, an employee of the health care provider, other than a chaplain or a social worker, or an employee, other than a chaplain or a social worker, of an inpatient health care facility in which the declarant is a patient. I am not the principal's health care agent. To the best of my knowledge, I am not entitled to and do not have a claim on the principal's estate.
Witness No. 1:
(print) Name.... Date....
Address....
Signature....
Witness No. 2:
(print) Name.... Date....
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....
28,2441
Section
2441. 155.40 (2) of the statutes is amended to read:
155.40 (2) If the health care agent is the principal's spouse or domestic partner under ch. 770 and, subsequent to the execution of a power of attorney for health care instrument, the marriage is annulled or divorce from the spouse is obtained or the domestic partnership under ch. 770 is terminated, the power of attorney for health care is revoked and the power of attorney for health care instrument is invalid.
28,2442
Section
2442. 157.05 of the statutes is amended to read:
157.05 Autopsy. Consent for a licensed physician to conduct an autopsy on the body of a deceased person shall be deemed sufficient when given by whichever one of the following assumes custody of the body for purposes of burial: Father, mother, husband, wife, child, guardian, next of kin, domestic partner under ch. 770, or in the absence of any of the foregoing, a friend, or a person charged by law with the responsibility for burial. If 2 or more such persons assume custody of the body, the consent of one of them shall be deemed sufficient.
28,2443
Section
2443. 157.06 (9) (a) 2. of the statutes is amended to read:
157.06 (9) (a) 2. The spouse or domestic partner under ch. 770 of the individual.
28,2443d
Section 2443d. 165.018 of the statutes is repealed.
28,2443m
Section 2443m. 165.03 of the statutes is created to read:
165.03 Funding for assistant district attorney and public defender retention pay. (1) Notwithstanding the purposes for which appropriations are made under s. 20.455, in each fiscal year, the attorney general may transfer to the appropriation account under s. 20.455 (3) (kb) a total of up to $1,000,000 from appropriation accounts under s. 20.455, except all of the following, for retention pay for assistant district attorneys and assistant state public defenders:
(a) A sum sufficient appropriation.
(b) An appropriation of federal moneys.
(c) An appropriation from which transfer of moneys under this subsection is prohibited under the constitution.
(2) (a) In this subsection:
1. "District attorney percentage" means the percentage of total assistant attorney positions that are assistant district attorney positions.
2. "Public defender percentage" means the percentage of total assistant attorney positions that are assistant state public defender positions.
3. "Total assistant attorney positions" means the total full-time equivalent assistant district attorney positions filled as of June 30th of a fiscal year plus the total full-time equivalent assistant state public defender positions filled on that date.
(b) If the attorney general transfers moneys under sub. (1) in a fiscal year, the attorney general shall on June 30 of that fiscal year transfer from the appropriation account under s. 20.455 (3) (kb) to the appropriation account under s. 20.475 (1) (kb) an amount equal to the amount transferred under sub. (1) multiplied by the district attorney percentage.
(c) If the attorney general transfers moneys under sub. (1) in a fiscal year, the attorney general shall on June 30 of that fiscal year transfer from the appropriation account under s. 20.455 (3) (kb) to the appropriation account under s. 20.550 (1) (kb) an amount equal to the amount transferred under sub. (1) multiplied by the public defender percentage.
165.25 (4) (ar) The department of justice shall furnish all legal services required by the department of agriculture, trade and consumer protection relating to the enforcement of ss. 91.68, 93.73, 100.171, 100.173, 100.174, 100.175, 100.177, 100.18, 100.182, 100.195, 100.20, 100.205, 100.207, 100.209, 100.21, 100.28, 100.37, 100.42, 100.50, 100.51, 100.55, and 846.45 and chs. 126, 136, 344, 704, 707, and 779, together with any other services as are necessarily connected to the legal services.
28,2446
Section
2446. 165.755 (1) (a) of the statutes is amended to read:
165.755 (1) (a) Except as provided in par. (b), a court shall impose under ch. 814 a crime laboratories and drug law enforcement surcharge of $8 $13 if the court imposes a sentence, places a person on probation, or imposes a forfeiture for a violation of state law or for a violation of a municipal or county ordinance.
28,2446m
Section 2446m. 165.755 (1) (b) of the statutes is amended to read:
165.755 (1) (b) A court may not impose the crime laboratories and drug law enforcement surcharge under par. (a) for a violation of s. 101.123 (2) (a), (am) 1., (ar), (bm), (br), or (bv) or (5) (b), for a financial responsibility violation under s. 344.62 (2), for a first violation of s. 23.33 (4c) (a) 2., 30.681 (1) (b) 1., 346.63 (1) (b), or 350.101 (1) (b), if the person who committed the violation had a blood alcohol concentration of 0.08 or more but less than 0.1 at the time of the violation, or for a violation of a state law or municipal or county ordinance involving a nonmoving traffic violation, a violation under s. 343.51 (1m) (b), or a safety belt use violation under s. 347.48 (2m).
28,2447m
Section 2447m. 165.785 of the statutes is created to read:
165.785 Crime alert network. (1) In addition to its duties under ss. 165.50 and 165.78, the department may develop, administer, and maintain an integrated crime alert network to provide information regarding known or suspected criminal activity, crime prevention, and missing or endangered children or adults to state agencies, law enforcement officers, and members of the private sector.
(2) The department may charge a fee to members of the private sector who receive information under sub. (1).
28,2448
Section
2448. 165.82 (1) (a) and (ag) of the statutes are consolidated, renumbered 165.82 (1) (a) and amended to read:
165.82 (1) (a) For each record check, except a fingerprint card record check, requested by a nonprofit organization, $2. (ag) For each record check, except a fingerprint card record check, requested or by a governmental agency, $5 $7.
28,2448d
Section 2448d. 165.82 (1) (a) of the statutes, as affected by 2009 Wisconsin Act .... (this act), is amended to read:
165.82 (1) (a) For each record check, except a fingerprint card record check, requested by a nonprofit organization, or by a governmental agency, $7 $2.
28,2448s
Section 2448s. 165.82 (1) (am) of the statutes is created to read:
165.82 (1) (am) For each record check, except a fingerprint card record check, requested by a governmental agency, $7.
28,2450
Section
2450. 165.85 (4) (b) 1d. f. of the statutes is created to read:
165.85 (4) (b) 1d. f. Training concerning cultural diversity, including sensitivity toward racial and ethnic differences. The training shall be designed to prevent the use of race, racial profiling, racial stereotyping, or other race-based discrimination or selection as a basis for detaining, searching, or arresting a person or for otherwise treating a person differently from persons of other races and shall emphasize the fact that the primary purposes of enforcement of traffic regulations are safety and equal and uniform enforcement under the law.
28,2450b
Section 2450b. 167.10 (1) (p) of the statutes is created to read:
