SB377,15,4 2MENTAL RETARDATION FACILITIES for the intellectually
3disabled
AND COMMUNITY MENTAL HEALTH
4 CENTERS CONSTRUCTION
SB377, s. 43 5Section 43. 150.96 (2) of the statutes is amended to read:
SB377,15,136 150.96 (2) "Facility for the mentally retarded individuals with an intellectual
7disability
" means a facility specially designed for the diagnosis, treatment,
8education, training or custodial care of the mentally retarded individuals with an
9intellectual disability
; including facilities for training specialists and sheltered
10workshops for the mentally retarded individuals with an intellectual disability, but
11only if such workshops are part of facilities which provide or will provide
12comprehensive services for the mentally retarded individuals with an intellectual
13disability
.
SB377, s. 44 14Section 44. 150.96 (4) of the statutes is amended to read:
SB377,15,2115 150.96 (4) "Nonprofit facility for the mentally retarded individuals with an
16intellectual disability
", and "nonprofit community mental health center" mean,
17respectively, a facility for the mentally retarded individuals with an intellectual
18disability
, and a community mental health center which is owned and operated by
19one or more nonprofit corporations or associations no part of the net earnings of
20which inures, or may lawfully inure, to the benefit of any private shareholder or
21individual.
SB377, s. 45 22Section 45. 150.963 (title) of the statutes is amended to read:
SB377,15,24 23150.963 (title) Construction of mental retardation facilities for the
24intellectually disabled
and community mental health centers.
SB377, s. 46 25Section 46. 150.963 (2) (a) of the statutes is amended to read:
SB377,16,4
1150.963 (2) (a) Making inventories of existing facilities, surveying the need for
2construction for facilities for the mentally retarded individuals with an intellectual
3disability
and community mental health centers, and developing programs of
4construction.
SB377, s. 47 5Section 47. 150.963 (2) (b) of the statutes is amended to read:
SB377,16,96 150.963 (2) (b) Developing and administering a state plan for the construction
7of public and other nonprofit facilities for the mentally retarded individuals with an
8intellectual disability
, and a state plan for the construction of public and other
9nonprofit community mental health centers.
SB377, s. 48 10Section 48. 150.965 of the statutes is amended to read:
SB377,16,20 11150.965 Construction programs. The department is directed to develop
12construction programs for facilities for the mentally retarded individuals with an
13intellectual disability
and community mental health centers for the mentally ill,
14which shall be based respectively on statewide inventories of existing facilities for
15the mentally retarded individuals with an intellectual disability and the mentally
16ill and surveys of need, and which shall provide in accordance with regulations
17prescribed under the federal act, for facilities which will provide adequate services
18for the mentally retarded individuals with an intellectual disability and adequate
19community mental health services for the people residing in this state and for
20furnishing needed services to persons unable to pay therefor.
SB377, s. 49 21Section 49. 150.97 of the statutes is amended to read:
SB377,17,2 22150.97 Standards for maintenance and operation. The department shall
23by regulation prescribe, and shall be authorized to enforce, standards for the
24maintenance and operation of facilities for the mentally retarded individuals with

1an intellectual disability
, and community mental health centers which receive
2federal aid for construction under the state plans.
SB377, s. 50 3Section 50. 150.975 of the statutes is amended to read:
SB377,17,9 4150.975 Applications. Applications for mental retardation facility for
5individuals with an intellectual disability
or community mental health center
6construction projects for which federal funds are requested shall be submitted to the
7department by the state, a political subdivision thereof or by a public or other
8nonprofit agency. Each application for a construction project shall conform to federal
9and state requirements.
SB377, s. 51 10Section 51. 150.983 of the statutes is amended to read:
SB377,17,20 11150.983 Mental retardation facilities Facilities for individuals with an
12intellectual disability
and community mental health centers construction
13funds.
The department may receive federal funds in behalf of, and transmit them
14to, applicants. In the general fund there is hereby established, separate and apart
15from all public moneys of this state, a mental retardation an intellectual disability
16facilities construction fund and a community mental health centers construction
17fund. Money received from the federal government for a construction project under
18this subchapter approved by the secretary shall be deposited to the credit of the
19appropriate fund and shall be used solely for payments to applicants for work
20performed, or purchases made, in carrying out the approved project.
SB377, s. 52 21Section 52. 155.20 (2) (a) 2. of the statutes is amended to read:
SB377,17,2322 155.20 (2) (a) 2. An intermediate care facility for persons with mental
23retardation
an intellectual disability, as defined in s. 46.278 (1m) (am).
SB377, s. 53 24Section 53. 155.30 (3) of the statutes is amended to read:
SB377,18,13
1155.30 (3) The department shall prepare and provide copies of a power of
2attorney for health care instrument and accompanying information for distribution
3in quantities to health care professionals, hospitals, nursing homes, multipurpose
4senior centers, county clerks, and local bar associations and individually to private
5persons. The department shall include, in information accompanying the copy of the
6instrument, at least the statutory definitions of terms used in the instrument,
7statutory restrictions on who may be witnesses to a valid instrument, a statement
8explaining that valid witnesses acting in good faith are statutorily immune from civil
9or criminal liability and a statement explaining that an instrument may, but need
10not, be filed with the register in probate of the principal's county of residence. The
11department may charge a reasonable fee for the cost of preparation and distribution.
12The power of attorney for health care instrument distributed by the department
13shall include the notice specified in sub. (1) and shall be in the following form:
SB377,18,1414 POWER OF ATTORNEY FOR HEALTH CARE
SB377,18,1515 Document made this.... day of.... (month),.... (year).
SB377,18,1716 CREATION OF POWER OF ATTORNEY
17 FOR HEALTH CARE
SB377,18,2518 I,.... (print name, address and date of birth), being of sound mind, intend by this
19document to create a power of attorney for health care. My executing this power of
20attorney for health care is voluntary. Despite the creation of this power of attorney
21for health care, I expect to be fully informed about and allowed to participate in any
22health care decision for me, to the extent that I am able. For the purposes of this
23document, "health care decision" means an informed decision to accept, maintain,
24discontinue or refuse any care, treatment, service or procedure to maintain, diagnose
25or treat my physical or mental condition.
SB377,19,2
1In addition, I may, by this document, specify my wishes with respect to making
2an anatomical gift upon my death.
SB377,19,33 DESIGNATION OF HEALTH CARE AGENT
SB377,19,184 If I am no longer able to make health care decisions for myself, due to my
5incapacity, I hereby designate.... (print name, address and telephone number) to be
6my health care agent for the purpose of making health care decisions on my behalf.
7If he or she is ever unable or unwilling to do so, I hereby designate.... (print name,
8address and telephone number) to be my alternate health care agent for the purpose
9of making health care decisions on my behalf. Neither my health care agent nor my
10alternate health care agent whom I have designated is my health care provider, an
11employee of my health care provider, an employee of a health care facility in which
12I am a patient or a spouse of any of those persons, unless he or she is also my relative.
13For purposes of this document, "incapacity" exists if 2 physicians or a physician and
14a psychologist who have personally examined me sign a statement that specifically
15expresses their opinion that I have a condition that means that I am unable to receive
16and evaluate information effectively or to communicate decisions to such an extent
17that I lack the capacity to manage my health care decisions. A copy of that statement
18must be attached to this document.
SB377,19,1919 GENERAL STATEMENT OF AUTHORITY GRANTED
SB377,20,220 Unless I have specified otherwise in this document, if I ever have incapacity I
21instruct my health care provider to obtain the health care decision of my health care
22agent, if I need treatment, for all of my health care and treatment. I have discussed
23my desires thoroughly with my health care agent and believe that he or she
24understands my philosophy regarding the health care decisions I would make if I

1were able. I desire that my wishes be carried out through the authority given to my
2health care agent under this document.
SB377,20,113 If I am unable, due to my incapacity, to make a health care decision, my health
4care agent is instructed to make the health care decision for me, but my health care
5agent should try to discuss with me any specific proposed health care if I am able to
6communicate in any manner, including by blinking my eyes. If this communication
7cannot be made, my health care agent shall base his or her decision on any health
8care choices that I have expressed prior to the time of the decision. If I have not
9expressed a health care choice about the health care in question and communication
10cannot be made, my health care agent shall base his or her health care decision on
11what he or she believes to be in my best interest.
SB377,20,1212 LIMITATIONS ON MENTAL HEALTH TREATMENT
SB377,20,1813 My health care agent may not admit or commit me on an inpatient basis to an
14institution for mental diseases, an intermediate care facility for persons with mental
15retardation
an intellectual disability, a state treatment facility or a treatment
16facility. My health care agent may not consent to experimental mental health
17research or psychosurgery, electroconvulsive treatment or drastic mental health
18treatment procedures for me.
SB377,20,2019 ADMISSION TO NURSING HOMES OR
20 COMMUNITY-BASED RESIDENTIAL FACILITIES
SB377,20,2221 My health care agent may admit me to a nursing home or community-based
22residential facility for short-term stays for recuperative care or respite care.
SB377,20,2523 If I have checked "Yes" to the following, my health care agent may admit me for
24a purpose other than recuperative care or respite care, but if I have checked "No" to
25the following, my health care agent may not so admit me:
SB377,21,1
11. A nursing home — Yes.... No....
SB377,21,22 2. A community-based residential facility — Yes.... No....
SB377,21,43 If I have not checked either "Yes" or "No" immediately above, my health care
4agent may admit me only for short-term stays for recuperative care or respite care.
SB377,21,55 PROVISION OF A FEEDING TUBE
SB377,21,106 If I have checked "Yes" to the following, my health care agent may have a
7feeding tube withheld or withdrawn from me, unless my physician has advised that,
8in his or her professional judgment, this will cause me pain or will reduce my comfort.
9If I have checked "No" to the following, my health care agent may not have a feeding
10tube withheld or withdrawn from me.
SB377,21,1311 My health care agent may not have orally ingested nutrition or hydration
12withheld or withdrawn from me unless provision of the nutrition or hydration is
13medically contraindicated.
SB377,21,1414 Withhold or withdraw a feeding tube — Yes.... No....
SB377,21,1615 If I have not checked either "Yes" or "No" immediately above, my health care
16agent may not have a feeding tube withdrawn from me.
SB377,21,1817 HEALTH CARE DECISIONS FOR
18 PREGNANT WOMEN
SB377,21,2219 If I have checked "Yes" to the following, my health care agent may make health
20care decisions for me even if my agent knows I am pregnant. If I have checked "No"
21to the following, my health care agent may not make health care decisions for me if
22my health care agent knows I am pregnant.
SB377,21,2323 Health care decision if I am pregnant — Yes.... No....
SB377,22,3
1If I have not checked either "Yes" or "No" immediately above, my health care
2agent may not make health care decisions for me if my health care agent knows I am
3pregnant.
SB377,22,54 STATEMENT OF DESIRES,
5 SPECIAL PROVISIONS OR LIMITATIONS
SB377,22,96 In exercising authority under this document, my health care agent shall act
7consistently with my following stated desires, if any, and is subject to any special
8provisions or limitations that I specify. The following are specific desires, provisions
9or limitations that I wish to state (add more items if needed):
SB377,22,1010 1) -
SB377,22,1111 2) -
SB377,22,1212 3) -
SB377,22,1513 INSPECTION AND DISCLOSURE OF
14 INFORMATION RELATING TO MY PHYSICAL
15 OR MENTAL HEALTH
SB377,22,1716 Subject to any limitations in this document, my health care agent has the
17authority to do all of the following:
SB377,22,1918 (a) Request, review and receive any information, oral or written, regarding my
19physical or mental health, including medical and hospital records.
SB377,22,2120 (b) Execute on my behalf any documents that may be required in order to obtain
21this information.
SB377,22,2222 (c) Consent to the disclosure of this information.
SB377,22,2323 (The principal and the witnesses all must sign the document at the same time.)
SB377,22,2424 SIGNATURE OF PRINCIPAL
SB377,22,2525 (person creating the power of attorney for health care)
SB377,23,1
1Signature....  Date....
SB377,23,32 (The signing of this document by the principal revokes all previous powers of
3attorney for health care documents.)
SB377,23,44 STATEMENT OF WITNESSES
SB377,23,155 I know the principal personally and I believe him or her to be of sound mind and
6at least 18 years of age. I believe that his or her execution of this power of attorney
7for health care is voluntary. I am at least 18 years of age, am not related to the
8principal by blood, marriage, or adoption, am not the domestic partner under ch. 770
9of the principal, and am not directly financially responsible for the principal's health
10care. I am not a health care provider who is serving the principal at this time, an
11employee of the health care provider, other than a chaplain or a social worker, or an
12employee, other than a chaplain or a social worker, of an inpatient health care facility
13in which the declarant is a patient. I am not the principal's health care agent. To
14the best of my knowledge, I am not entitled to and do not have a claim on the
15principal's estate.
SB377,23,1616 Witness No. 1:
SB377,23,1717 (print) Name.... Date....
SB377,23,1818 Address....
SB377,23,1919 Signature....
SB377,23,2020 Witness No. 2:
SB377,23,2121 (print) Name.... Date....
SB377,23,2222 Address....
SB377,23,2323 Signature....
SB377,23,2524 STATEMENT OF HEALTH CARE AGENT AND
25 ALTERNATE HEALTH CARE AGENT
SB377,24,4
1I understand that.... (name of principal) has designated me to be his or her
2health care agent or alternate health care agent if he or she is ever found to have
3incapacity and unable to make health care decisions himself or herself. .... (name of
4principal) has discussed his or her desires regarding health care decisions with me.
SB377,24,55 Agent's signature....
SB377,24,66 Address....
SB377,24,77 Alternate's signature....
SB377,24,88 Address....
SB377,24,119 Failure to execute a power of attorney for health care document under chapter
10155 of the Wisconsin Statutes creates no presumption about the intent of any
11individual with regard to his or her health care decisions.
SB377,24,1312 This power of attorney for health care is executed as provided in chapter 155
13of the Wisconsin Statutes.
SB377,24,1414 ANATOMICAL GIFTS (optional)
SB377,24,1515 Upon my death:
SB377,24,1716 .... I wish to donate only the following organs or parts: .... (specify the organs or
17parts).
SB377,24,1818 .... I wish to donate any needed organ or part.
SB377,24,1919 .... I wish to donate my body for anatomical study if needed.
SB377,24,2220 .... I refuse to make an anatomical gift. (If this revokes a prior commitment that
21I have made to make an anatomical gift to a designated donee, I will attempt to notify
22the donee to which or to whom I agreed to donate.)
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