AB695,18,1210 (e) This section does not limit a custodian's ability to obtain or to require a
11fiduciary or designated recipient requesting disclosure or termination under this
12section to obtain a court order that does all of the following:
AB695,18,1313 1. Specifies that an account belongs to the protected person or principal.
AB695,18,1514 2. Specifies that there is sufficient consent from the protected person or
15principal to support the requested disclosure.
AB695,18,1616 3. Contains any findings required by law other than this section.
AB695,18,1817 (f) A custodian and its officers, employees, and agents are immune from
18liability for an act or omission done in good faith in compliance with this section.
AB695,18,21 19(16) Uniformity of application and construction. In applying and construing
20this uniform act, consideration must be given to the need to promote uniformity of
21the law with respect to its subject matter among states that enact it.
AB695,19,2 22(17) Relation to Electronic Signatures in Global and National Commerce
23Act.
This section modifies, limits, or supersedes the Electronic Signatures in Global
24and National Commerce Act, 15 USC 7001 et seq., but does not modify, limit, or

1supersede section 101 (c) of that act, 15 USC 7001 (c), or authorize electronic delivery
2of any of the notices described in section 103 (b) of that act, 15 USC 7003 (b).
AB695,19,3 3(18) Applicability. (a) This section applies to all of the following:
AB695,19,54 1. A fiduciary acting under a will or power of attorney executed before, on, or
5after the effective date of this subdivision .... [LRB inserts date].
AB695,19,76 2. A personal representative acting for a decedent who died before, on, or after
7the effective date of this subdivision .... [LRB inserts date].
AB695,19,108 3. A guardianship or conservatorship proceeding, whether pending in a court
9or commenced before, on, or after the effective date of this subdivision .... [LRB
10inserts date].
AB695,19,1211 4. A trustee acting under a trust created before, on, or after the effective date
12of this subdivision .... [LRB inserts date].
AB695,19,1413 (b) This section applies to a custodian only if the user resides in this state or
14resided in this state at the time of the user's death.
AB695,19,1615 (c) This section does not apply to a digital asset of an employer used by an
16employee in the ordinary course of the employer's business.
AB695,3 17Section 3. 155.20 (9) of the statutes is created to read:
AB695,19,1918 155.20 (9) The health care agent may access the principal's digital assets, as
19defined in s. 112.12 (2) (j), as provided under s. 112.12.
AB695,4 20Section 4. 155.30 (3) (form) of the statutes is amended to read:
AB695,19,2121 155.30 (3) (form)
AB695,19,2222 POWER OF ATTORNEY FOR HEALTH CARE
AB695,19,2323 Document made this.... day of.... (month),.... (year).
AB695,19,2524 CREATION OF POWER OF ATTORNEY
25 FOR HEALTH CARE
AB695,20,8
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.
AB695,20,109 In addition, I may, by this document, specify my wishes with respect to making
10an anatomical gift upon my death.
AB695,20,1111 DESIGNATION OF HEALTH CARE AGENT
AB695,21,212 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
19employee of my health care provider, an employee of a health care facility in which
20I am 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.
AB695,21,33 GENERAL STATEMENT OF AUTHORITY GRANTED
AB695,21,104 Unless I have specified otherwise in this document, if I ever have incapacity I
5instruct my health care provider to obtain the health care decision of my health care
6agent, if I need treatment, for all of my health care and treatment. I have discussed
7my desires thoroughly with my health care agent and believe that he or she
8understands my philosophy regarding the health care decisions I would make if I
9were able. I desire that my wishes be carried out through the authority given to my
10health care agent under this document.
AB695,21,1911 If I am unable, due to my incapacity, to make a health care decision, my health
12care agent is instructed to make the health care decision for me, but my health care
13agent should try to discuss with me any specific proposed health care if I am able to
14communicate in any manner, including by blinking my eyes. If this communication
15cannot be made, my health care agent shall base his or her decision on any health
16care choices that I have expressed prior to the time of the decision. If I have not
17expressed a health care choice about the health care in question and communication
18cannot be made, my health care agent shall base his or her health care decision on
19what he or she believes to be in my best interest.
AB695,21,2020 LIMITATIONS ON MENTAL HEALTH TREATMENT
AB695,22,221 My health care agent may not admit or commit me on an inpatient basis to an
22institution for mental diseases, an intermediate care facility for persons with an
23intellectual disability, a state treatment facility or a treatment facility. My health
24care agent may not consent to experimental mental health research or

1psychosurgery, electroconvulsive treatment or drastic mental health treatment
2procedures for me.
AB695,22,43 ADMISSION TO NURSING HOMES OR
4 COMMUNITY-BASED RESIDENTIAL FACILITIES
AB695,22,65 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.
AB695,22,97 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:
AB695,22,1010 1. A nursing home — Yes.... No....
AB695,22,1111 2. A community-based residential facility — Yes.... No....
AB695,22,1312 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.
AB695,22,1414 PROVISION OF A FEEDING TUBE
AB695,22,1915 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.
AB695,22,2220 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.
AB695,22,2323 Withhold or withdraw a feeding tube — Yes.... No....
AB695,22,2524 If I have not checked either "Yes" or "No" immediately above, my health care
25agent may not have a feeding tube withdrawn from me.
AB695,23,2
1HEALTH CARE DECISIONS FOR
2 PREGNANT WOMEN
AB695,23,63 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.
AB695,23,77 Health care decision if I am pregnant — Yes.... No....
AB695,23,108 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.
AB695,23,11 11ACCESS TO DIGITAL ASSETS
AB695,23,15 12If I have checked "Yes" to the following, my health care agent may access the
13content of electronic communications on my behalf. If I have checked "No" to the
14following, my health care agent may not access the content of electronic
15communications on my behalf.
AB695,23,16 16Access to content of electronic communications — Yes.... No....
AB695,23,18 17If I have not checked either "Yes" or "No" immediately above, my agent may not
18access the content of electronic communications on my behalf.
AB695,23,2019 STATEMENT OF DESIRES,
20 SPECIAL PROVISIONS OR LIMITATIONS
AB695,23,2421 In exercising authority under this document, my health care agent shall act
22consistently with my following stated desires, if any, and is subject to any special
23provisions or limitations that I specify. The following are specific desires, provisions
24or limitations that I wish to state (add more items if needed):
AB695,23,2525 1) -
AB695,24,1
12) -
AB695,24,22 3) -
AB695,24,53 INSPECTION AND DISCLOSURE OF
4 INFORMATION RELATING TO MY PHYSICAL
5 OR MENTAL HEALTH
AB695,24,76 Subject to any limitations in this document, my health care agent has the
7authority to do all of the following:
AB695,24,98 (a) Request, review and receive any information, oral or written, regarding my
9physical or mental health, including medical and hospital records.
AB695,24,1110 (b) Execute on my behalf any documents that may be required in order to obtain
11this information.
AB695,24,1212 (c) Consent to the disclosure of this information.
AB695,24,14 13(d) Access my digital assets, other than the content of my electronic
14communication, and catalogues of my electronic communications.
AB695,24,1515 (The principal and the witnesses all must sign the document at the same time.)
AB695,24,1616 SIGNATURE OF PRINCIPAL
AB695,24,1717 (person creating the power of attorney for health care)
AB695,24,1818 Signature....  Date....
AB695,24,2019 (The signing of this document by the principal revokes all previous powers of
20attorney for health care documents.)
AB695,24,2121 STATEMENT OF WITNESSES
AB695,25,722 I know the principal personally and I believe him or her to be of sound mind and
23at least 18 years of age. I believe that his or her execution of this power of attorney
24for health care is voluntary. I am at least 18 years of age, am not related to the
25principal by blood, marriage, or adoption, am not the domestic partner under ch. 770

1of the principal, and am not directly financially responsible for the principal's health
2care. I am not a health care provider who is serving the principal at this time, an
3employee of the health care provider, other than a chaplain or a social worker, or an
4employee, other than a chaplain or a social worker, of an inpatient health care facility
5in which the declarant is a patient. I am not the principal's health care agent. To
6the best of my knowledge, I am not entitled to and do not have a claim on the
7principal's estate.
AB695,25,88 Witness No. 1:
AB695,25,99 (print) Name.... Date....
AB695,25,1010 Address....
AB695,25,1111 Signature....
AB695,25,1212 Witness No. 2:
AB695,25,1313 (print) Name.... Date....
AB695,25,1414 Address....
AB695,25,1515 Signature....
AB695,25,1716 STATEMENT OF HEALTH CARE AGENT AND
17 ALTERNATE HEALTH CARE AGENT
AB695,25,2118 I understand that.... (name of principal) has designated me to be his or her
19health care agent or alternate health care agent if he or she is ever found to have
20incapacity and unable to make health care decisions himself or herself. .... (name of
21principal) has discussed his or her desires regarding health care decisions with me.
AB695,25,2222 Agent's signature....
AB695,25,2323 Address....
AB695,25,2424 Alternate's signature....
AB695,25,2525 Address....
AB695,26,3
1Failure to execute a power of attorney for health care document under chapter
2155 of the Wisconsin Statutes creates no presumption about the intent of any
3individual with regard to his or her health care decisions.
AB695,26,54 This power of attorney for health care is executed as provided in chapter 155
5of the Wisconsin Statutes.
AB695,26,66 ANATOMICAL GIFTS (optional)
AB695,26,77 Upon my death:
AB695,26,98 .... I wish to donate only the following organs or parts: .... (specify the organs or
9parts).
AB695,26,1010 .... I wish to donate any needed organ or part.
AB695,26,1111 .... I wish to donate my body for anatomical study if needed.
AB695,26,1412 .... I refuse to make an anatomical gift. (If this revokes a prior commitment that
13I have made to make an anatomical gift to a designated donee, I will attempt to notify
14the donee to which or to whom I agreed to donate.)
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