AB1078,7,15 13(2) The attending provider and consulting provider of a qualified individual
14shall have met each of their respective requirements as set forth in ss. 156.13 and
15156.15.
AB1078,7,21 16(3) Notwithstanding sub. (1), if an individual's attending provider has
17medically determined that the individual will, within reasonable medical judgment,
18die within 15 days after making an initial oral request under sub. (1), the 15-day
19waiting period set forth in sub. (1) is waived and the individual may reiterate the oral
20request to the attending provider as required under sub. (1) at any time after making
21the initial oral request.
AB1078,7,23 22(4) At the time an individual makes the second oral request, the individual's
23attending provider shall offer the individual an opportunity to rescind the request.
AB1078,8,2 24(5) Oral and written requests for medical aid in dying may be made only by the
25requesting individual and may not be made by the individual's surrogate

1decision-maker, health care proxy, attorney-in-fact for health care, or through an
2advance health care directive.
AB1078,8,6 3(6) If an individual decides to transfer care to another provider, the former
4provider shall transfer all relevant medical records, including written
5documentation of the date of the individual's request or requests concerning medical
6aid in dying.
AB1078,8,12 7156.11 Form of written request. (1) A valid written request for medication
8under this chapter shall be signed and dated by the requesting individual, and
9witnessed by at least one person who, in the presence of the requesting individual,
10attests that, to the best of the witness's knowledge and belief, the individual is
11capable, acting voluntarily, and is not being coerced nor unduly influenced to sign the
12request.
AB1078,8,14 13(2) The witness required under this section must be a person who is not any
14of the following:
AB1078,8,1515 (a) A relative of the requesting individual by blood, marriage, or adoption.
AB1078,8,1816 (b) A person who at the time the request is signed would be entitled to any
17portion of the estate of the requesting individual upon death under any will or by
18operation of law.
AB1078,8,2019 (c) An owner, operator, or employee of a health care facility where the
20requesting individual is receiving medical treatment or is a resident.
AB1078,8,22 21(3) The requesting individual's attending provider at the time the request is
22signed may not be a witness.
AB1078,8,23 23(4) The requesting individual's interpreter may not be a witness.
AB1078,8,25 24(5) The written request for medication shall be in substantially the following
25form:
AB1078,9,1
1REQUEST FOR MEDICATION
AB1078,9,22 TO END MY LIFE IN A
AB1078,9,33 PEACEFUL MANNER
AB1078,9,64 I, .... (insert name), am an adult of sound mind. I have been diagnosed with ....
5(insert description of terminal disease), and given a prognosis of six months or less
6to live.
AB1078,9,117 I have been fully informed of the feasible alternatives, concurrent or additional
8treatment opportunities for my terminal disease, including comfort care, palliative
9care, hospice care, or pain control and the potential risks and benefits of each. I have
10been offered or received resources or referrals to pursue these alternative,
11concurrent or additional treatment opportunities for my terminal disease.
AB1078,9,1612 I have been fully informed of the nature of the medication to be prescribed and
13the risks and benefits, including that the likely outcome of self-administering the
14medication is death. I understand that I can rescind this request at any time, that
15I am under no obligation to fill the prescription once written nor to self-administer
16the medication if I obtain it.
AB1078,9,2017 I request that my attending provider furnish a prescription for medication that
18will end my life in a peaceful manner if I choose to self-administer it, and I authorize
19my attending provider to contact a pharmacist to dispense the prescription at a time
20of my choosing.
AB1078,9,2121 I make this request voluntarily, free from coercion or undue influence.
AB1078,9,2222 Signed: ....
AB1078,9,2323 Dated: ....
AB1078,9,2424 Witness Signature: ....
AB1078,9,2525 Dated: ....
AB1078,10,3
1156.13 Attending provider responsibilities. (1) The attending provider
2for an individual shall do all of the following with regard to requests for medication
3under this chapter:
AB1078,10,54 (a) Determine whether the individual has a terminal disease with a prognosis
5of six months or less and is mentally capable.
AB1078,10,96 (b) Confirm that the individual's request for medication under this chapter does
7not arise from coercion or undue influence by asking the individual about coercion
8and influence, outside the presence of other persons and except for an interpreter as
9necessary.
AB1078,10,1010 (c) Inform the individual of all of the following:
AB1078,10,1111 1. The individual's diagnosis.
AB1078,10,1212 2. The individual's prognosis.
AB1078,10,1413 3. The potential risks, benefits, and probable result of self-administering the
14prescribed medication to bring about a peaceful death.
AB1078,10,1715 4. The potential benefits and risks of feasible alternatives, including
16concurrent or additional treatment options for the individual's terminal disease,
17palliative care, comfort care, hospice care, and pain control.
AB1078,10,1918 5. The individual's right to rescind the request for medication under this
19chapter at any time and in any manner.
AB1078,10,2120 (d) Inform the individual that there is no obligation to fill the prescription nor
21an obligation to self-administer the medication, if it is obtained.
AB1078,10,2422 (e) Provide the individual with a referral for comfort care, palliative care,
23hospice care, pain control, or any other end-of-life treatment option as requested or
24as clinically indicated.
AB1078,11,3
1(f) Refer the individual to a consulting provider for medical confirmation that
2the individual requesting medication under this chapter both has a terminal disease
3with a prognosis of six months or less and is mentally capable.
AB1078,11,54 (g) Include the consulting provider's written determination, as provided under
5s. 156.15, in the individual's medical record.
AB1078,11,86 (h) Refer the individual to a licensed mental health care provider if the
7attending provider observes signs that the individual may not be capable of making
8an informed decision.
AB1078,11,119 (i) Include the licensed mental health care provider's written determination,
10as provided under s. 156.17, in the individual's medical record, if such determination
11was requested.
AB1078,11,1312 (j) Inform the individual of the benefits of notifying the next of kin of the
13individual's decision to request medication under this chapter.
AB1078,11,1414 (k) Fulfill all medical record documentation requirements.
AB1078,11,1715 (L) Ensure that all procedures required in order to fulfill a request for
16medication under this chapter are followed before providing a prescription to a
17qualified individual for medication under this chapter, including all of the following:
AB1078,11,1918 1. Confirm that the individual has made an informed decision to obtain a
19prescription for medication under this chapter.
AB1078,11,2120 2. Offer the individual an opportunity to rescind the request for medication
21under this chapter.
AB1078,12,222 3. Educate the individual on the recommended procedure for
23self-administering the medication to be prescribed; the safe-keeping and proper
24disposal of unused medication in accordance with state and federal law; the

1importance of having another person present when the individual self-administers
2the medication to be prescribed; and not taking the medication in a public place.
AB1078,12,113 (m) Deliver the prescription personally, by mail, or through an authorized
4electronic transmission to a licensed pharmacist who will dispense the medication,
5including any ancillary medications, to the attending provider, to the qualified
6individual, or to an individual expressly designated by the qualified individual in
7person or with a signature required on delivery, by mail service or by messenger
8service, or if authorized by the federal drug enforcement agency, dispense the
9prescribed medication, including any ancillary medications, to the qualified
10individual or an individual expressly designated by the qualified individual in
11person.
AB1078,12,1612 (n) Document in the qualified individual's medical record the individual's
13diagnosis and prognosis, determination of mental capability, the date of the oral
14request or requests, a copy of the written request, a notation that the requirements
15under this chapter have been completed, and identification of the medication and
16ancillary medications prescribed to the qualified individual under this chapter.
AB1078,12,18 17(2) Notwithstanding any other provision of law, the attending provider may
18sign the individual's death certificate.
AB1078,12,21 19156.15 Consulting provider responsibilities. A consulting provider for an
20individual shall do all of the following with regard to requests for medication under
21this chapter:
AB1078,12,22 22(1) Evaluate the individual and the individual's relevant medical records.
AB1078,12,24 23(2) Confirm, in writing, to the individual's attending provider that all of the
24following are true:
AB1078,12,2525 (a) The individual has a terminal disease with prognosis of six months or less.
AB1078,13,4
1(b) The individual is mentally capable. If the consulting provider is unable to
2confirm that the individual is mentally capable, the consulting provider shall provide
3documentation that the consulting provider has referred the individual for further
4evaluation in accordance with s. 157.17.
AB1078,13,55 (c) The individual is acting voluntarily, free from coercion or undue influence.
AB1078,13,11 6156.17 Referral for confirmation that the requesting individual is
7mentally capable. (1)
If either an attending provider or a consulting provider is
8unable to confirm that an individual making a request for medication under this
9chapter is capable of making an informed decision, the attending provider or the
10consulting provider shall refer the individual to a licensed mental health care
11provider for determination regarding mental capability.
AB1078,13,14 12(2) The licensed mental health care provider who evaluates the individual
13under this section shall submit to the requesting attending provider or consulting
14provider a written determination of whether the individual is mentally capable.
AB1078,13,18 15(3) If the licensed mental health care provider determines that the individual
16is not mentally capable, the individual may not be deemed a qualified individual and
17the attending provider may not prescribe medication to the individual under this
18chapter.
AB1078,13,22 19156.19 Safe disposal of unused medications. A person who has custody or
20control of medication prescribed under this chapter after a qualified individual's
21death shall dispose of the medication by lawful means in accordance with state and
22federal guidelines.
AB1078,14,3 23156.21 No duty to provide medical aid in dying. (1) A provider shall
24provide sufficient information to an individual with a terminal disease regarding
25available options, the alternatives, and the foreseeable risks and benefits of each

1option so that the individual is able to make informed decisions regarding his or her
2end-of-life health care, but a provider may choose whether or not to practice medical
3aid in dying under this chapter.
AB1078,14,5 4(2) If a provider is unable or unwilling to fulfill an individual's request for
5medication under this chapter, the provider shall do all of the following:
AB1078,14,76 (a) Document the date of the individual's request in the individual's medical
7record.
AB1078,14,98 (b) Upon request, transfer the individual's medical records to the new provider,
9consistent with federal and state law.
AB1078,14,13 10(3) A provider may not engage in false, misleading, or deceptive practices
11relating to a willingness to qualify an individual or provide a prescription to a
12qualified individual under this chapter. Intentionally misleading an individual
13constitutes coercion.
AB1078,14,20 14156.23 Health care facility permissible prohibitions and duties. (1) A
15health care facility may prohibit providers from qualifying, prescribing, or
16dispensing medication under this chapter while performing duties for the facility.
17A prohibiting facility must provide express advance notice in writing at the time of
18hiring, contracting with, or privileging providers and staff, and on a yearly basis
19thereafter. A health care facility that fails to provide advance notice in writing
20waives the right to enforce the prohibition or prohibitions.
AB1078,14,25 21(2) If an individual who is a patient at a prohibiting health care facility and has
22made a request concerning medical aid in dying wishes to transfer care to another
23health care facility, the prohibiting facility shall coordinate a timely transfer,
24including transfer of the individual's medical records that include notation of the
25date the individual first made a request concerning medical aid in dying.
AB1078,15,3
1(3) No health care facility may prohibit a provider from doing any of the
2following in fulfilling the requirements of informed consent and meeting the medical
3of standard of care:
AB1078,15,64 (a) Providing information to an individual regarding the individual's health
5status, including diagnosis, prognosis, recommended treatment, treatment
6alternatives, and any potential risks to the individual's health.
AB1078,15,127 (b) Providing information about available services, relevant community
8resources, and how to access those resources to obtain the care of the individual's
9choice. Providing information about available services, including health care
10services available under this chapter, information about relevant community
11resources, and information about how to access those resources to obtain the care of
12the individual's choice.
AB1078,15,1513 (c) Prescribing medication under this chapter for a qualified individual outside
14the scope of the provider's employment or contract with the prohibiting facility and
15off the premises of the prohibiting facility.
AB1078,15,1916 (d) Being present when a qualified individual self-administers medication
17prescribed under this chapter or at the time of death, if requested by the qualified
18individual or his or her representative and outside the scope of the provider's
19employment or contractual duties with the prohibiting facility.
AB1078,16,3 20(4) A health care facility may not engage in false, misleading, or deceptive
21practices relating to its policy regarding end-of-life care services, including whether
22it has a policy that prohibits affiliated providers from determining an individual's
23qualification for medical aid in dying or writing a prescription for a qualified
24individual under this chapter, or intentionally denying an individual access to
25medication under this chapter by failing to transfer an individual and the

1individual's medical records to another provider in a timely manner. Intentionally
2misleading an individual or deploying misinformation to obstruct access to services
3under this chapter constitutes coercion or undue influence.
AB1078,16,8 4(5) If any part of this chapter is found to be in conflict with federal requirements
5that are a prescribed condition to receipt of federal funds, the conflicting part of this
6chapter is inoperative solely to the extent of the conflict with respect to the facility
7directly affected, and such finding or determination does not affect the operation of
8the remainder of the chapter.
AB1078,16,13 9156.25 Immunities for actions in good faith; prohibition against
10reprisals
. (1) No person or health care facility shall be subject to civil or criminal
11liability or professional disciplinary action, including censure, suspension, loss of
12license, loss of privileges, loss of membership, or any other penalty, for engaging in
13good faith compliance with this chapter.
AB1078,16,19 14(2) No provider, health care facility, professional organization, or association
15shall subject a provider to discharge, demotion, censure, discipline, suspension, loss
16of license, loss of privileges, loss of membership, discrimination, or any other penalty
17for providing medical aid in dying in accordance with the medical standard of care
18and in good faith under this chapter, except if a provider acts in violation of a health
19care facility's valid prohibition or prohibitions as set forth under s. 156.23.
AB1078,17,2 20(3) No provider, health care facility, professional organization, or association
21shall subject a provider to discharge, demotion, censure, discipline, suspension, loss
22of license, loss of privileges, loss of membership, discrimination, or any other penalty
23for providing medical aid in dying in accordance with the medical standard of care
24and in good faith under this chapter while engaged in the outside practice of medicine

1and off the facility premises or for providing scientific and accurate information
2about medical aid in dying to an individual when discussing end-of-life care options.
AB1078,17,9 3(4) An individual is not subject to civil or criminal liability or professional
4discipline if, at the request of a qualified individual, the individual is present outside
5the scope of the individual's employment contract and off the facility premises when
6the qualified individual self-administers medication under this chapter or at the
7time of death. An individual who is present may, without civil or criminal liability,
8assist the qualified individual by preparing the medication prescribed under this
9chapter.
AB1078,17,12 10(5) A request by an individual for and the provision of medication under this
11chapter alone does not constitute neglect or elder abuse for any purpose of law, nor
12shall it be the sole basis for appointment of a guardian or conservator.
AB1078,17,14 13(6) This chapter does not limit civil liability for intentional or negligent
14misconduct.
AB1078,17,18 15156.27 Reporting requirements. (1) The department shall create a
16checklist form and a follow up form for attending providers to facilitate collection of
17the information described in this chapter and post these forms to the department's
18Internet site.
AB1078,17,21 19(2) Within 30 calendar days of providing a prescription for medication under
20this chapter, an attending provider shall submit to the department a completed
21checklist form, as provided under sub. (1), with all of the following information:
AB1078,17,2222 (a) The qualified individual's name and date of birth.
AB1078,17,2323 (b) The qualified individual's terminal diagnosis and prognosis.
AB1078,17,2424 (c) Notice that the requirements under this chapter have been completed.
AB1078,17,2525 (d) Notice that medication has been prescribed under this chapter.
AB1078,18,4
1(3) Within 60 calendar days of notification of a qualified individual's death from
2self-administration of medication prescribed under this chapter, the attending
3provider shall submit to the department a follow up form, as provided under sub. (1),
4with all of the following information:
AB1078,18,55 (a) The qualified individual's name and date of birth.
AB1078,18,66 (b) The date of the qualified individual's death.
AB1078,18,87 (c) A notation of whether or not the qualified individual was enrolled in hospice
8services at the time of the qualified individual's death.
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