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Witness No. 2:
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(print) Name.... Date....
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Address....
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Signature....
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STATEMENT OF HEALTH CARE AGENT AND
17
ALTERNATE HEALTH CARE AGENT
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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.
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Agent's signature....
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Address....
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Alternate's signature....
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Address....
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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.
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This power of attorney for health care is executed as provided in chapter 155
5of the Wisconsin Statutes.
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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
9parts).
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.... I wish to donate any needed organ or part.
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.... I wish to donate my body for anatomical study if needed.
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.... 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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Failing to check any of the lines immediately above creates no presumption
16about my desire to make or refuse to make an anatomical gift.
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Signature.... Date....
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18Section
5. 244.41 (1) (i) of the statutes is created to read:
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244.41
(1) (i) Access the content of an electronic communication, as defined in
20s. 112.12 (2) (f), sent or received by the principal.
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21Section
6. 244.43 (9m) of the statutes is created to read:
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244.43
(9m) Access a catalogue of electronic communications, as defined in s.
23112.12 (2) (d), sent or received by the principal, and the principal's digital assets, as
24defined in s. 112.12 (2) (j), other than the content of electronic communications, as
25defined in s. 112.12 (2) (f)
.
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1Section
7. 244.61 (form) of the statutes is amended to read:
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2244.61 (form)
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3WISCONSIN STATUTORY FORM
4
POWER OF ATTORNEY
5
FOR FINANCES AND PROPERTY
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IMPORTANT INFORMATION
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THIS POWER OF ATTORNEY AUTHORIZES ANOTHER PERSON (YOUR
8AGENT) TO MAKE DECISIONS CONCERNING YOUR PROPERTY FOR YOU
9(THE PRINCIPAL). YOUR AGENT WILL BE ABLE TO MAKE DECISIONS AND
10ACT WITH RESPECT TO YOUR PROPERTY (INCLUDING YOUR MONEY)
11WHETHER OR NOT YOU ARE ABLE TO ACT FOR YOURSELF. THE MEANING
12OF AUTHORITY OVER SUBJECTS LISTED ON THIS FORM IS EXPLAINED IN
13THE UNIFORM POWER OF ATTORNEY FOR FINANCES AND PROPERTY ACT
14IN CHAPTER 244 OF THE WISCONSIN STATUTES.