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HEALTH CARE DECISIONS FOR
25
PREGNANT WOMEN
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1If I have checked "Yes" to the following, my health care agent may make health
2care decisions for me even if my agent knows I am pregnant. If I have checked "No"
3to the following, my health care agent may not make health care decisions for me if
4my 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
7agent may not make health care decisions for me if my health care agent knows I am
8pregnant.
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STATEMENT OF DESIRES,
10
SPECIAL PROVISIONS OR LIMITATIONS
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In exercising authority under this document, my health care agent shall act
12consistently with my following stated desires, if any, and is subject to any special
13provisions or limitations that I specify. The following are specific desires, provisions
14or limitations that I wish to state (add more items if needed):
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INSPECTION AND DISCLOSURE OF
19
INFORMATION RELATING TO MY PHYSICAL
20
OR MENTAL HEALTH
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Subject to any limitations in this document, my health care agent has the
22authority to do all of the following:
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(a) Request, review and receive any information, oral or written, regarding my
24physical 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 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
9attorney 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
12at least 18 years of age. I believe that his or her execution of this power of attorney
13for health care is voluntary. I am at least 18 years of age, am not related to the
14principal by blood, marriage
, or adoption
, am not the domestic partner under ch. 770
15of the principal, and am not directly financially responsible for the principal's health
16care. I am not a health care provider who is serving the principal at this time, an
17employee of the health care provider, other than a chaplain or a social worker, or an
18employee, other than a chaplain or a social worker, of an inpatient health care facility
19in which the declarant is a patient. I am not the principal's health care agent. To
20the best of my knowledge, I am not entitled to and do not have a claim on the
21principal'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 AND
6
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)
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Upon my death:
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.... I wish to donate only the following organs or parts: .... (specify the organs or
23parts).
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.... I wish to donate any needed organ or part.
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.... I wish to donate my body for anatomical study if needed.
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1.... I refuse to make an anatomical gift. (If this revokes a prior commitment that
2I have made to make an anatomical gift to a designated donee, I will attempt to notify
3the donee to which or to whom I agreed to donate.)
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Failing to check any of the lines immediately above creates no presumption
5about my desire to make or refuse to make an anatomical gift.
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Signature.... Date....
AB75, s. 2441
7Section
2441. 155.40 (2) of the statutes is amended to read:
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155.40
(2) If the health care agent is the principal's spouse
or domestic partner
9under ch. 770 and, subsequent to the execution of a power of attorney for health care
10instrument, the marriage is annulled or divorce from the spouse is obtained
or the
11domestic partnership under ch. 770 is terminated, the power of attorney for health
12care is revoked and the power of attorney for health care instrument is invalid.
AB75, s. 2442
13Section
2442. 157.05 of the statutes is amended to read:
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14157.05 Autopsy. Consent for a licensed physician to conduct an autopsy on
15the body of a deceased person shall be deemed sufficient when given by whichever
16one of the following assumes custody of the body for purposes of burial: Father,
17mother, husband, wife, child, guardian, next of kin
, domestic partner under ch. 770,
18or in the absence of any of the foregoing, a friend, or a person charged by law with
19the responsibility for burial. If 2 or more such persons assume custody of the body,
20the consent of one of them shall be deemed sufficient.
AB75, s. 2443
21Section
2443. 157.06 (9) (a) 2. of the statutes is amended to read:
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157.06
(9) (a) 2. The spouse
or domestic partner under ch. 770 of the individual.
AB75, s. 2444
23Section
2444. 165.25 (4) (ar) of the statutes is amended to read:
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165.25
(4) (ar) The department of justice shall furnish all legal services
25required by the department of agriculture, trade and consumer protection relating
1to the enforcement of ss.
91.68, 93.73, 100.171, 100.173, 100.174, 100.175, 100.177,
2100.18, 100.182, 100.195, 100.20, 100.205, 100.207, 100.209, 100.21, 100.28, 100.37,
3100.42, 100.50,
and 100.51,
and 100.55
, and chs. 126, 136, 344, 704, 707, and 779,
4together with any other services as are necessarily connected to the legal services.
AB75, s. 2445
5Section
2445. 165.60 of the statutes is amended to read:
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6165.60 Law enforcement. The department of justice is authorized to enforce
7ss. 101.123 (2),
(5), (2m), and (8), 944.30, 944.31, 944.33, 944.34, 945.02 (2), 945.03
8(1m), and 945.04 (1m) and ch. 108 and is invested with the powers conferred by law
9upon sheriffs and municipal police officers in the performance of those duties. This
10section does not deprive or relieve sheriffs, constables, and other local police officers
11of the power and duty to enforce those sections, and those officers shall likewise
12enforce those sections.
AB75, s. 2446
13Section
2446. 165.755 (1) (a) of the statutes is amended to read:
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165.755
(1) (a) Except as provided in par. (b), a court shall impose under ch. 814
15a crime laboratories and drug law enforcement surcharge of
$8 $13 if the court
16imposes a sentence, places a person on probation, or imposes a forfeiture for a
17violation of state law or for a violation of a municipal or county ordinance.
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18Section
2447. 165.755 (1) (b) of the statutes is amended to read:
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165.755
(1) (b) A court may not impose the crime laboratories and drug law
20enforcement surcharge under par. (a) for a violation of s. 101.123 (2)
(a), (am) 1., (ar),
21(bm), (br), or (bv) or (5) (b) or (2m), for a first violation of s. 23.33 (4c) (a) 2., 30.681
22(1) (b) 1., 346.63 (1) (b), or 350.101 (1) (b), if the person who committed the violation
23had a blood alcohol concentration of 0.08 or more but less than 0.1 at the time of the
24violation, or for a violation of a state law or municipal or county ordinance involving
1a nonmoving traffic violation, a violation under s. 343.51 (1m) (b), or a safety belt use
2violation under s. 347.48 (2m).
AB75, s. 2448
3Section
2448. 165.82 (1) (a) and (ag) of the statutes are consolidated,
4renumbered 165.82 (1) (a) and amended to read:
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165.82
(1) (a) For each record check, except a fingerprint card record check,
6requested by a nonprofit organization,
$2. (ag) For each record check, except a
7fingerprint card record check, requested or by a governmental agency,
$5 $7.
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8Section
2449. 165.842 of the statutes is created to read:
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9165.842 Motor vehicle stops; collection and analysis of information;
10annual report. (1) Definitions. In this section:
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(a) "Department" means the department of justice.
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(b) "Law enforcement agency" has the meaning given in s. 165.77 (1) (b).
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(c) "Law enforcement officer" means a person who is employed by a law
14enforcement agency for the purpose of detecting and preventing crime and enforcing
15laws or ordinances and who is authorized to make arrests for violations of the laws
16or ordinances that the person is employed to enforce, whether that enforcement
17authority extends to all laws or ordinances or is limited to specific laws or ordinances.
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(d) "Motor vehicle stop" means a stop or detention of a motor vehicle that is
19traveling in, or the detention of an occupied motor vehicle that is already stopped in,
20any public or private place in a county having a population of 125,000 or more, for
21the purpose of investigating any alleged or suspected violation of a state or federal
22law or city, village, town, or county ordinance.
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23(2) Information collection required. All persons in charge of law
24enforcement agencies shall obtain, or cause to be obtained, all of the following
1information with respect to each motor vehicle stop made on or after January 1, 2011,
2by a law enforcement officer employed by the law enforcement agency:
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(a) The name, address, gender, and race of the operator of the motor vehicle.
4If information regarding the operator's race is not available to the officer through an
5electronic database or other similar source, the officer shall subjectively select the
6operator's race from the following list:
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1. Caucasian.
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2. African American.
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3. Hispanic.
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4. American Indian or Alaska Native.
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5. Asian or Pacific Islander.
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(b) The reason that the officer stopped or detained the motor vehicle.
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(c) The make and year of the motor vehicle.
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(d) The date, time, and location of the motor vehicle stop.
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(e) Whether or not a law enforcement officer conducted a search of the motor
16vehicle, the operator, or any passenger and, if so, whether the search was with
17consent or by other means.
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(f) The name, address, gender, and race of any person searched, with the officer
19obtaining information regarding the person' race from any available electronic
20database or other similar source if possible or, if not possible, by subjectively
21selecting the person's race from the list under par. (a).
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(g) The name and badge number of the officer making the motor vehicle stop.
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23(3) Submission of information collected. The person in charge of a law
24enforcement agency shall submit the information obtained under sub. (2) to the
25department using the form prescribed by the rules promulgated under sub. (5) and
1in accordance with the reporting schedule established under the rules promulgated
2under sub. (5).
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3(4) Analysis and report by department. (a) The department shall compile the
4information submitted to it by law enforcement agencies under sub. (3) and shall
5analyze the information, along with any other relevant information, to determine,
6both for each law enforcement agency submitting information under sub. (3) and as
7an aggregated total for all law enforcement agencies submitting information under
8sub. (3), all of the following:
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1. Whether the number of motor vehicle stops and searches involving motor
10vehicles operated or occupied by members of a racial minority compared to the
11number of motor vehicle stops and searches involving motor vehicles operated or
12occupied solely by persons who are not members of a racial minority is
13disproportionate based on an estimate of the population and characteristics of
14persons traveling on highways in the counties for which information is submitted
15under sub. (3), on an estimate of the populations and characteristics of persons
16traveling on highways in the counties for which information is submitted under sub.
17(3) who are violating a law or ordinance, or on some other relevant population
18estimate.
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2. A determination as to whether any disproportion found under subd. 1. is the
20result of racial profiling, racial stereotyping, or other race-based discrimination or
21selective enforcement.
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(b) For each year, the department shall prepare an annual report that
23summarizes the information submitted to it under sub. (3) concerning motor vehicle
24stops made during the year and that describes the methods and conclusions of its
25analysis of the information. On or before March 31, 2012, and on or before each
1March 31 thereafter, the department shall submit the annual report required under
2this paragraph to the legislature under s. 13.172 (2), to the governor, and to the
3director of state courts.
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4(5) Rules. The department shall promulgate rules to implement the
5requirements of this section, including rules prescribing a form for use in obtaining
6information under sub. (2) and establishing a schedule for submitting the
7information obtained to the department. The department shall make the form
8prescribed by its rules available to law enforcement agencies. The department may,
9by rule, require the collection of information in addition to that specified in sub. (2)
10(a) to (g) if the department determines that the information will help to make the
11determinations required under sub. (4) (a).
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12(6) Access to records. Information collected under sub. (2) is not subject to
13inspection or copying under s. 19.35 (1).
AB75, s. 2450
14Section
2450. 165.85 (4) (b) 1d. f. of the statutes is created to read: