AB75,1306,1911
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.
AB75,1306,2020
LIMITATIONS ON MENTAL HEALTH TREATMENT
AB75,1306,2521
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 mental
23retardation, a state treatment facility or a treatment facility. My health care agent
24may not consent to experimental mental health research or psychosurgery,
25electroconvulsive treatment or drastic mental health treatment procedures for me.
AB75,1307,2
1ADMISSION TO NURSING HOMES OR
2
COMMUNITY-BASED RESIDENTIAL FACILITIES
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My health care agent may admit me to a nursing home or community-based
4residential facility for short-term stays for recuperative care or respite care.
AB75,1307,75
If I have checked "Yes" to the following, my health care agent may admit me for
6a purpose other than recuperative care or respite care, but if I have checked "No" to
7the 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....
AB75,1307,1110
If I have not checked either "Yes" or "No" immediately above, my health care
11agent may admit me only for short-term stays for recuperative care or respite care.
AB75,1307,1212
PROVISION OF A FEEDING TUBE
AB75,1307,1713
If I have checked "Yes" to the following, my health care agent may have a
14feeding tube withheld or withdrawn from me, unless my physician has advised that,
15in his or her professional judgment, this will cause me pain or will reduce my comfort.
16If I have checked "No" to the following, my health care agent may not have a feeding
17tube withheld or withdrawn from me.
AB75,1307,2018
My health care agent may not have orally ingested nutrition or hydration
19withheld or withdrawn from me unless provision of the nutrition or hydration is
20medically contraindicated.
AB75,1307,2121
Withhold or withdraw a feeding tube — Yes.... No....
AB75,1307,2322
If I have not checked either "Yes" or "No" immediately above, my health care
23agent may not have a feeding tube withdrawn from me.
AB75,1307,2524
HEALTH CARE DECISIONS FOR
25
PREGNANT WOMEN
AB75,1308,4
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.
AB75,1308,55
Health care decision if I am pregnant — Yes.... No....
AB75,1308,86
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.
AB75,1308,109
STATEMENT OF DESIRES,
10
SPECIAL PROVISIONS OR LIMITATIONS
AB75,1308,1411
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):
AB75,1308,2018
INSPECTION AND DISCLOSURE OF
19
INFORMATION RELATING TO MY PHYSICAL
20
OR MENTAL HEALTH
AB75,1308,2221
Subject to any limitations in this document, my health care agent has the
22authority to do all of the following:
AB75,1308,2423
(a) Request, review and receive any information, oral or written, regarding my
24physical or mental health, including medical and hospital records.
AB75,1309,2
1(b) Execute on my behalf any documents that may be required in order to obtain
2this information.
AB75,1309,33
(c) Consent to the disclosure of this information.
AB75,1309,44
(The principal and the witnesses all must sign the document at the same time.)
AB75,1309,55
SIGNATURE OF PRINCIPAL
AB75,1309,66
(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.)
AB75,1309,1010
STATEMENT OF WITNESSES
AB75,1309,2111
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....
AB75,1310,1
1Witness No. 2:
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(print) Name.... Date....
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Signature....
AB75,1310,65
STATEMENT OF HEALTH CARE AGENT AND
6
ALTERNATE HEALTH CARE AGENT
AB75,1310,107
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.
AB75,1310,1111
Agent's signature....
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Address....
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Alternate's signature....
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Address....
AB75,1310,1715
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.
AB75,1310,1918
This power of attorney for health care is executed as provided in chapter 155
19of the Wisconsin Statutes.
AB75,1310,2020
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.
AB75,1310,2525
.... I wish to donate my body for anatomical study if needed.
AB75,1311,3
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.)
AB75,1311,54
Failing to check any of the lines immediately above creates no presumption
5about my desire to make or refuse to make an anatomical gift.
AB75,1311,66
Signature.... Date....
AB75, s. 2441
7Section
2441. 155.40 (2) of the statutes is amended to read:
AB75,1311,128
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:
AB75,1311,20
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:
AB75,1311,2222
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:
AB75,1312,424
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:
AB75,1312,12
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:
AB75,1312,1714
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.
AB75, s. 2447
18Section
2447. 165.755 (1) (b) of the statutes is amended to read:
AB75,1313,219
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:
AB75,1313,75
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.
AB75, s. 2449
8Section
2449. 165.842 of the statutes is created to read:
AB75,1313,10
9165.842 Motor vehicle stops; collection and analysis of information;
10annual report. (1) Definitions. In this section:
AB75,1313,1111
(a) "Department" means the department of justice.
AB75,1313,1212
(b) "Law enforcement agency" has the meaning given in s. 165.77 (1) (b).
AB75,1313,1713
(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.
AB75,1313,2218
(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.
AB75,1314,2
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:
AB75,1314,63
(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.