We all need help sometimes, but some of us need it more than others. In situations when you can’t longer make decisions on your own, and especially when you can’t make decisions on your mental and physical health, you can find a person who will make these decisions for you. You can choose the person who you trust with your health and then appoint him as your representative. To do this, you need to create the “Medical Power of Attorney Form” (or the MPA form).
By doing so, you give your representative the right to:
This is a serious decision. That’s why you need to think twice before choosing someone as your representative in such a complex question. You have to be sure this person will represent your will. To protect yourself, you can discuss your preferences for treatment with him and explain to him his role in the whole process.
Remember that you have all the right to cancel the medical power of attorney form any time you like, but only while you’re still capable of doing so.
Wisconsin power of attorney templates – visit for additional Wisconsin-specific power of attorney forms that you might require.
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The minute doctors decide that you’re unable to speak for yourself in the context of your mental and physical health, you lose your voice forever. That’s why it’s extremely important to choose the right person as your representative and to discuss with him all possible measures of caring for you in the days when you no longer have a sound mind.
In some states, local laws require notarial attestation of the form, while others ask for the presence of witnesses while completing the form. It differs from state to state.
In Wisconsin, the MPA is regulated by chapter 155 of the Wisconsin Statutes.
According to it, to complete the MPA, two witnesses are required, and here’s something which these witnesses can’t be:
The principal, the one creating the MPA, has to be at least 18 years old. He has to tell his family about the completed form, and they have the right to know who will represent his health care interests. They also have the right to know where the MPA is kept.
Both witnesses and the principal need to sign the form at the same time. To sign the form, the principal has to be of a sound mind, and that’s the kind of decision only doctors can make. Two physicians, or a psychologist and a physician can identify the incapacity of the principal.
Something that can’t be identified as the incapacity:
In Wisconsin, a principal can revoke and annul the MPA at any time and any place by:
A principal can also show his or her will of revoking the form by writing the paper with his intentions (which needs to be signed and dated by a principal) or by expressing his or her intention verbally in the presence of two witnesses. At this time, the principal’s health representative has to record the date, place, and time of the revocation.
No health care provider or health care facility can be charged with a crime or with professional misconduct for:
Any health care decision of the principal made under the MPA can’t be considered as constituting suicide.
Insurers have to pay for all medical services and goods of the principal, even if it’s the principal’s representative who requests them.
|Document Name||Wisconsin Medical Power of Attorney Form|
|State Form Name||Wisconsin Power of Attorney for Health Care|
|State Laws||Wisconsin Statutes and Annotations, Sections 155.01 to 155.80|
|Signing Requirements||Two Witnesses|
|Who Can’t Be the Agent?||Section 155.05(3)|
|Who Can’t Be the Witness?||Section 155.10(2)|
|Avg. Time to Fill Out||8 minutes|
|# of Fillable Fields||21|
|Available Formats||Adobe PDF|
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HCPOA forms enable you to establish a representative who can manage your health-related affairs after you end up incapacitated. These are the states MPOA forms are requested in most often.
Here are the instructions on completing the MPA form in Wisconsin. Using them, you can complete this form on your own.
In the beginning, you need to download the template of the MDPOA form. Use our form building software to make this process as quick as possible.
Write in the heading of the form your personal information: full name, place, date of birth, age, full address, email, and telephone number.
In this section, you need to state your representative, fill in the form of his or her full name, full address, email, and telephone number.
Here you appoint your second representative, write down his data, as of his or her full name, address, and phone number. Plus, state the type of relationships with your alternate health care agent.
Also, specify the conditions on which you can be admitted incapable.
In this section, you need to:
After all the settled instructions, after reading and rereading them very carefully, you have to sign the form and specify the date of completing the document.
You need two witnesses to complete the form. They have to sign the document simultaneously as you do and have to indicate the date of leaving their signatures in your MPA form.
Friendly reminder: your representative or alternate health care agent can’t be your witnesses.
Your representative and alternate health care agent have to state they understand your desires and requests on the medical treatment, and after that, they need to sign the form and write down their addresses.
In this section, you can also specify your thoughts on anatomical gifts. e.g., whether you want to donate your organs after your death or not, and if you want to give them for anatomical study.
Leave your signature, indicate the date, and the MPA form is finally complete.
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