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Blank Living Will Form for Wisconsin State

The Wisconsin Living Will form is a legal document that allows individuals to express their preferences regarding medical treatment in the event they become unable to communicate their wishes. This form ensures that healthcare providers respect a person's choices about life-sustaining measures. To take control of your medical decisions, consider filling out the form by clicking the button below.

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Table of Contents

Document Overview

Fact Name	Description
Purpose	A Wisconsin Living Will outlines a person's wishes regarding medical treatment in case they become unable to communicate their preferences.
Governing Law	The Wisconsin Living Will is governed by Chapter 154 of the Wisconsin Statutes.
Eligibility	Any adult who is at least 18 years old can create a Living Will in Wisconsin.
Signature Requirements	The form must be signed by the individual and witnessed by at least two adults, who cannot be related to the individual or beneficiaries.
Revocation	A Living Will can be revoked at any time by the individual, either verbally or in writing.
Healthcare Proxy	A Living Will can be used in conjunction with a healthcare proxy, allowing someone to make decisions on behalf of the individual.
Storage	It is recommended to keep the Living Will in a safe place and share copies with family members and healthcare providers.

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Documents used along the form

When preparing a Wisconsin Living Will, it's essential to consider additional forms and documents that can complement your advance healthcare planning. Each of these documents serves a unique purpose and can help ensure that your healthcare preferences are respected. Below is a list of commonly used forms alongside the Living Will.

Durable Power of Attorney for Health Care: This document allows you to appoint someone to make healthcare decisions on your behalf if you become unable to do so. It gives your chosen agent the authority to interpret your wishes and make choices that align with your values.
Do Not Resuscitate (DNR) Order: A DNR order is a specific request not to receive CPR or other life-saving measures in the event of cardiac arrest. This document is particularly important for individuals who wish to avoid aggressive medical interventions.
Physician Orders for Life-Sustaining Treatment (POLST): The POLST form translates your healthcare wishes into actionable medical orders. It is designed for individuals with serious illnesses and ensures that medical staff are aware of your preferences in emergencies.
Advance Directive: This is a broader term that encompasses both the Living Will and Durable Power of Attorney for Health Care. It outlines your healthcare preferences and appoints someone to make decisions if you are unable to communicate.
Organ Donation Registration: If you wish to donate your organs after death, registering your decision can ease the process for your family. This document indicates your consent to organ donation and can be included in your advance care planning.
Health Care Proxy: Similar to the Durable Power of Attorney, a health care proxy designates a specific person to make medical decisions for you. This form can be particularly useful in situations where you cannot voice your preferences.

By considering these additional documents, you can create a comprehensive plan that reflects your healthcare wishes. This ensures that your loved ones and medical providers understand your desires, giving you peace of mind and clarity in times of need.

Document Sample

Wisconsin Living Will Template

This Living Will is created in accordance with Wisconsin state laws governing advance directives. It provides guidance on medical treatment preferences in the event that you are unable to communicate your wishes.

Personal Information:

Name: ___________________________
Date of Birth: _____________________
Address: __________________________
City: _____________________________
State: ____________________________
ZIP Code: _________________________

Declaration:

I, the undersigned, declare this document to be my Living Will. I want it to guide my healthcare providers regarding my treatment preferences if I become terminally ill or permanently unconscious and unable to communicate my wishes.

Healthcare Preferences:

If I am diagnosed with a terminal condition, I do not wish to receive the following treatments:

Life-sustaining treatment: _____________
Cardiopulmonary resuscitation (CPR): _____________
Mechanical ventilation: _____________
Artificial nutrition and hydration: ____________

If I am in a permanent non-responsive state, I wish for the following:

Comfort care only: _____________
Pain management: _____________
Spiritual guidance: _____________

Appointment of Health Care Agent:

I appoint the following individual as my health care agent to make health care decisions on my behalf if I am unable to do so:

Name: ___________________________
Phone Number: ___________________
Relationship: ______________________

Signatures:

This Living Will is valid only when signed by me. By signing below, I affirm that I am of sound mind and have the capacity to make this decision.

Signature: ___________________________

Date: ________________________________