52.10(1)(1) If an adult with a functional impairment decides voluntarily, without coercion, to enter into a supported decision-making agreement with a supporter, that adult may, in the agreement, authorize the supporter to do any of the following: 52.10(1)(a)(a) Provide supported decision-making to the adult with a functional impairment, including assistance in understanding the options, responsibilities, and consequences of that person’s life decisions, without making those decisions on behalf of that person. 52.10(1)(b)(b) Assist the adult with a functional impairment in accessing, collecting, and obtaining information that is relevant to a given life decision, including medical, psychological, financial, educational, or treatment records, from any person. 52.10(1)(c)(c) Assist the adult with a functional impairment in understanding the information described in par. (b). 52.10(1)(d)(d) Assist the adult with a functional impairment in communicating the adult’s decisions to appropriate persons. 52.10(2)(2) A supporter is not a surrogate decision maker for the adult with a functional impairment and does not have the authority to sign legal documents on behalf of the adult with a functional impairment or bind the adult with a functional impairment to a legal agreement. 52.10 HistoryHistory: 2017 a. 345; 2021 a. 238 s. 44. 52.1252.12 Authority of supporter. A supporter may exercise the authority granted to the supporter in the supported decision-making agreement. 52.12 HistoryHistory: 2017 a. 345; 2021 a. 238 s. 44. 52.1452.14 Term of agreement; revocation. 52.14(1)(1) Except as otherwise provided in this section, a supported decision-making agreement extends until terminated by either party or by the terms of the agreement. 52.14(2)(2) A supported decision-making agreement is terminated if any of the following is true: 52.14(2)(a)(a) County adult protective services substantiated an allegation of neglect or abuse by the supporter. 52.14(2)(b)(b) The supporter is found criminally liable for conduct described under par. (a). 52.14(2)(c)(c) There is a restraining order against the supporter as described under s. 813.123. 52.14(3)(3) An adult with a functional impairment may revoke his or her supported decision-making agreement and invalidate the supported decision-making agreement at any time by doing any of the following: 52.14(3)(a)(a) Canceling, defacing, obliterating, burning, tearing, or otherwise destroying the supported decision-making agreement or directing another in the presence of the adult with a functional impairment to so destroy the supported decision-making agreement. 52.14(3)(b)(b) Executing a statement, in writing, that is signed and dated by the adult with a functional impairment, expressing his or her intent to revoke the supported decision-making agreement. 52.14(3)(c)(c) Verbally expressing the intent of the adult with a functional impairment to revoke the supported decision-making agreement, in the presence of 2 witnesses. 52.14(4)(4) Unless the supported decision-making agreement provides a different method for the supporter’s resignation, a supporter may resign by giving notice to the adult with a functional impairment. 52.14 HistoryHistory: 2017 a. 345; 2021 a. 238 ss. 44, 45. 52.1652.16 Access to personal information. 52.16(1)(1) A supporter is only authorized to assist the adult with a functional impairment in accessing, collecting, or obtaining information that is relevant to a decision authorized under the supported decision-making agreement. 52.16(2)(2) A supporter may assist with accessing or obtaining any information that will help the adult with a functional impairment make health care decisions, including medical, psychological, financial, education, or treatment records or research under ss. 51.30 and 146.83 and the federal Health Insurance Portability and Accountability Act of 1996, 45 CFR 164.502. A supporter may only access or obtain patient health care records, as defined under s. 146.81 (4), if the adult with a functional impairment has signed a release allowing the supporter to see protected health information, as defined under s. 146.816 (1) (f). 52.16(3)(3) A supporter may assist with accessing or obtaining any information on education records under the federal Family Educational Rights and Privacy Act of 1974, 20 USC 1232g, if the adult with a functional impairment has signed a release allowing the supporter to access information under this subsection. 52.16(4)(4) The supporter shall ensure the information under this section is kept privileged and confidential, as applicable, and is not subject to unauthorized access, use, or disclosure. 52.16(5)(5) Notwithstanding the existence of a supported decision-making agreement, an adult with a functional impairment continues to have unrestricted access to personal information without the assistance of a supporter. 52.16(6)(6) Notwithstanding the existence of a supported decision-making agreement, an adult with a functional impairment is able to request and receive assistance on any decision that is not covered under the supported decision-making agreement at any time. 52.16 HistoryHistory: 2017 a. 345; 2021 a. 238 s. 44. 52.1852.18 Authorization and witnesses. 52.18(1)(1) An adult with a functional impairment and his or her supporter entering into a supported decision-making agreement must sign and date the agreement in the presence of 2 or more subscribing witnesses or a notary public. 52.18(2)(2) If the adult with a functional impairment and his or her supporter choose to sign and date the supported decision-making agreement before witnesses, the attesting witnesses must be at least 18 years of age. 52.18 HistoryHistory: 2017 a. 345; 2021 a. 238 s. 44. 52.2052.20 Supported decision-making agreement instrument; form. 52.20(1)(1) A supported decision-making agreement is valid if it is in writing, entered into voluntarily as described under s. 52.10, signed and dated as described under s. 52.18, and in substantially the following form: SUPPORTED DECISION-MAKING AGREEMENT
APPOINTMENT OF SUPPORTER
I, .... (insert name), make this agreement voluntarily and of my own free will.
I agree and designate that
Name of supporter ....
Address of supporter ....
E-mail address of supporter ....
Phone number(s) of supporter ....
is my supporter. For the following everyday life decisions, if I have checked “Yes,” my supporter may help me with that type of decision, but if I have checked “No,” my supporter may not help me with that type of decision:
Obtaining food, clothing, and shelter — Yes.... No....
Taking care of my physical health — Yes.... No....
Managing my financial affairs — Yes.... No....
Taking care of my mental health — Yes.... No....
Applying for public benefits — Yes.... No....
Assistance with seeking vocational rehabilitation services and other vocational supports — Yes.... No....
The following are other decisions I have specifically identified that I would like assistance with ....
If I have not checked either “Yes” or “No” or specifically identified and listed a decision immediately above, my supporter may not help me with that type of decision.
My supporter is not allowed to make decisions for me. To help me with my decisions, my supporter may do any of the following, if I have checked “Yes”:
1. Help me access, collect, or obtain information, including records, relevant to a decision. If I have checked “Yes,” my supporter may help me access, collect, or obtain the type of information specified, including relevant records, but if I have checked “No,” or I have not checked either “Yes” or “No,” my supporter may not help me access, collect, or obtain that type of information:
Medical — Yes.... No....
Psychological — Yes.... No....
Financial — Yes.... No....
Education — Yes.... No....
Treatment — Yes.... No....
Other — Yes.... No.... (If “Yes,” specify the other type(s) of information with which the supporter may assist ....)
2. Help me understand my options so I can make an informed decision.
Yes.... No....
3. Help me communicate my decision to appropriate persons.
Yes.... No....
4. Help me access appropriate personal records, including protected health information under the Health Insurance Portability and Accountability Act, the Family Educational Rights and Privacy Act, and other records that may or may not require a release for specific decisions I want to make.
Yes.... No....
EFFECTIVE DATE OF SUPPORTED
DECISION-MAKING AGREEMENT
This supported decision-making agreement is effective immediately and will continue until .... (insert date), or until the agreement is terminated by my supporter or me or by operation of law.
(print) Name of person designating a supporter ....
Signature ....
Date ....
CONSENT OF SUPPORTER
I know .... (name of person) personally or I have received proof of his or her identity and I believe him or her to be at least 18 years of age and entering this agreement knowingly and voluntarily. I am at least 18 years of age.
I, .... (name of supporter), consent to act as a supporter under this agreement.
Supporter:
(print) Name ....
Address ....
E-mail address ....
Phone number(s) ....
Signature ....
Date ....
STATEMENT AND SIGNATURE OF WITNESSES
OR SIGNATURE OF NOTARY
(This agreement must be signed either by 2 witnesses who are at least 18 years of age or by a notary public.)
OPTION I: WITNESSES
I know .... (name of person) personally or I have received proof of his or her identity and I believe him or her to be at least 18 years of age and entering this agreement knowingly and voluntarily. I am at least 18 years of age.
Witness No. 1:
(print) Name ....
Address ....
Phone number(s) ....
Signature ....
Date ....
Witness No. 2:
(print) Name ....
