Advance care planning: Have a say in your care

Watch a video tutorial for how to complete a State of Wisconsin Power of Attorney for Health Care

State of Wisconsin POA-HC

Short form allowing you to choose up to two health care agents.

• English - State of Wisconsin Power of Attorney for Health Care (pdf)

• Spanish - State of Wisconsin Power of Attorney for Health Care (pdf)

Wisconsin Medical Society Advance Directive, including Power of Attorney for Health Care
(formerly known as Honoring Choices Wisconsin)

Expanded form allowing you to choose up to three health care agents and document additional health care wishes.

• English - Advance Directive including Power of Attorney for Health Care (pdf)

• Spanish - Advance Directive including Power of Attorney for Health Care (pdf)

POA-HC forms in other languages

State of Wisconsin Living Will (Declaration to Health Care Professionals) (pdf)

• English - Illinois Power of Attorney for Health Care (pdf)

• Spanish - Illinois Power of Attorney for Health Care (pdf)

• Illinois Living Will (pdf)

Find advance directives for other states

Your health care agent must be at least 18 years old. This person can be a family member, a friend or a trusted individual. They do not need to live near you if they are available by phone when needed. Your health care agent may not be your health care provider.

List your selected health care agents in consecutive order. Avoid listing two or more individuals (co-agents) on the same line.

The most important consideration is whether the person you are choosing to be your health care agent is willing to follow your wishes about your health care decisions, even if they might not agree with them. Will they be able to understand the choices surrounding your health condition? Will the person be able to clearly communicate with health care providers about your health care needs and wishes?

This is an important conversation to have with your health care agent(s). Consider discussing your:

• Values and priorities: What does living well mean to you? What do you value most about your physical and mental health? What factors are most important to you (i.e., independence, living at home, pain management, time with loved ones, religious/spiritual beliefs, etc.)?

• Medical concerns: Do you have any existing medical conditions that your health care agent(s) should be aware of? Have you or a loved one had any past experiences (good or bad) with serious illness or hospitalization and how might those experiences influence your health care choices? In what situations would you want or not want life-sustaining treatments (i.e., breathing machine, CPR, feeding tubes, dialysis, etc.)?

• The Conversation Project (pdf) can help guide you through how to have this important discussion.

No, next of kin (including spouses) have no legal authority in Wisconsin. Creating a POA-HC and selecting your spouse as your health care agent is the only way to ensure your spouse can legally make health care decisions for you.

No, your health care agent(s) do not need to be present.

In Wisconsin, if your health condition changes and two providers determine you are no longer able to make your own health care decisions, the health care team will look to your designated health care agent. You will always be included to the extent you are able to communicate your wishes.

Responsibilities of a health care agent (pdf)

If you do not have someone to designate as your health care agent, it is strongly recommended that you still document your wishes by using the Wisconsin Medical Society Advance Directive including Power of Attorney for Health Care (pdf).

In Part 1, you can check the bottom box, “I do not have a Health Care Agent. Instead, I want Part 3 of this document to guide my health care.”

You can change your POA-HC at any time by completing a new one. The form with the most recent date is the valid one. Provide new copies of the POA-HC to your health care providers and notify your health care agent(s) that you have updated your form.

Perform at least one of the following:

• Execute a new POA-HC (recommended option)

• Sign and date a written statement noting the revocation

• Verbally revoke the POA-HC in front of two witnesses

• Destroy all copies of the POA-HC

Please remember to update any health care facilities who have a copy of your POA-HC on file.

If you selected your spouse as one of your health care agents and later get divorced, your POA-HC is no longer valid. If you would like your former spouse to remain as one of your health care agents, you will need to create a new POA-HC after the date of the divorce.

If you do not complete a POA-HC and are later unable to make your own health care decisions, there might be health care decisions that need to be made which no one else is authorized to make for you. In the Wisconsin, a family member is not automatically authorized to make health care decisions for you unless you complete a POA-HC naming the family member as your agent. Without a POA-HC, it might be necessary for your family or others to ask a court to appoint a guardian of the person for you. This process can be costly, time-consuming and stressful.

Yes, most states will honor a properly executed POA-HC.

Keep your POA-HC in an accessible area where loved ones will know where to find it. Give a copy to your clinic/hospital.