Wisconsin Living Will Declaration Form

A Wisconsin living will is a legal document that enables a person who is in a vegetative state to convey the treatment choices they would want to receive while still alive. In addition, the healthcare representative should create and maintain an up-to-date medical power of attorney for the patient as well as a living will on behalf of the patient. A living will be signed in the presence of two (2) witnesses.

Wisconsin living will

Wisconsin Living Will Declaration Form

Laws and statutes to adhere to for Wisconsin living will

Requirements needed to complete the signing process-

It is necessary for a minimum of two (2) witnesses to be present to witness the signing of a document for the signing to be considered legal (154.03).

Section 154.03 of the Code

How and what to put into writing for the Wisconsin living will

Step 1: A copy of the Wisconsin Declaration for Health-Care Professionals should be obtained as the first step in the procedure.

This website contains a "PDF" form that may be used to make a Wisconsin Declaration To Health Care Professionals, also known as a Wisconsin Living Will, in the state of Wisconsin. You may download the form by clicking here. We've added a button that will take you to an example picture for fast and simple access (see the labeled item "PDF"). You may also download a copy of this statement by selecting "Adobe PDF" from the drop-down menu above.

Step 2:  It is necessary to re-read the Wisconsin Declarant's Introduction in its entirety for the second time throughout this procedure.

You'll find an overview of applicable laws, as well as the circumstances in which this problem will be overlooked or overturned by Wisconsin State Law, in this section. Those who will be distributing the papers in Wisconsin should spend some time familiarizing themselves with the form's content.

Step 3: Require the identification of the Wisconsin Declarant who is the author of the Living Will.

Upon being knocked unconscious, the Wisconsin Declarant wishes to have his or her medical instructions for treatment written down so that the Wisconsin Physician and Medical Personnel present may carry them out. The beginning phrase of this proclamation, as a result, must include his or her entire name in the first sentence. Before the terms "...being of sound mind" and "...being of the sound body" are written, the Wisconsin Declarant's complete name should be typed into the empty area provided at the beginning of the document (or Patient).

Step 4:  You will talk about the patient's wishes for treatment as they approach the end of their life or are facing a terminal diagnosis.

He or she will likely be compelled to sign the Wisconsin Patient's Declaration at some point in the future. Although the Patient's name was all that was needed to bind this statement together in the first paragraph, the Wisconsin Declarant's preferences will need to be articulated more explicitly in the following parts, which will be discussed below. According to the definition in "1," the first item, a "Terminal Condition" is a medical condition that the Wisconsin Patient has acquired. Expert physicians in Wisconsin have determined that the patient's medical condition is incurable and that no medical intervention will be effective in preventing his death from occurring. Even if the Wisconsin patient is getting tube feedings or not, it is the responsibility of the medical team to ensure that he or she gets enough nourishment and hydration. A tick beneath item 1 must be chosen to indicate that the Wisconsin patient agrees with the idea of being fed and hydrated by a feeding tube. This piece of literature is titled "If I Have A Terminal Condition..." and it can be found here.

A selection in this area must be selected as soon as the Wisconsin Patient has been informed that his or her condition has been officially designated as a "Terminal Condition," or that no more mechanical feedings will be administered to the patient. "No, I Don't Want Feeding Tubes..." is a checkbox that you may choose while selecting this option.

It makes no difference whether of the statements above is chosen; this item will remain in its default state. As a result of his terminal disease, the Wisconsin patient may become incompetent and need nutrition and fluids delivered via a feeding tube. If the Wisconsin patient has not chosen tube feeding, he or she may need it (i.e. feeding tube down the throat or intravenously).

Step 5: It is necessary to indicate whether or not a Wisconsin patient is on life support in this procedure.

For the first time, the Wisconsin Patient has voiced their opinions on "life support" therapy in addition to "permanent vegetative state" treatment in the state of Wisconsin. This statement describes the Wisconsin Patient or Declarant as a "vegetable" who has had "...all Cerebral Cortex Functions paused" as a result of "...all Cerebral Cortex Functions halted" (see page 1). To indicate that the patient of Wisconsin is in agreement with the Medical Staff or accompanying Physician using life-sustaining therapies to keep his or her body functioning when it is incapable, check the "Yes..." box in item 2 of the consent form.

If the Wisconsin Patient is in a permanent condition of "Persistent Vegetative State" and has not expressly requested that life-sustaining treatments be delivered, selecting "No..." for item 2 is essential (i.e. dialysis, artificial respiration).

If no action is done on this page, the default selection will be utilized. Unless a Wisconsin Declarant specifies that the treatment must be limited, in which case all required care will be supplied, any therapy that is necessary to extend the patient's life shall be administered.

Step 6: If a patient has been in a coma for an extended amount of time, the Wisconsin Declarant must make a judgment on whether or not to provide tube feeding.

When a Wisconsin patient is in a persistent vegetative state, the proclamation must address both the issue of life support and the issue of artificial feeding and nourishment. Wisconsin Patients may note in item 3 of the consent form that they desire to be maintained well-fed and hydrated if they are in a prolonged coma. Choose "Yes, I would like feeding tubes" from the drop-down choice if you wish to use feeding tubes.

Whether or if the Wisconsin Declarant wants to keep his or her body's food and hydration levels stable during a prolonged vegetative state is a decision that must be made by the Declarant. Select the appropriate option from the drop-down box. I do not want feeding tubes to be utilized in any way. Following this decision, all feeding and hydration treatments, including intravenous nourishment supplies, will be suspended.

In the absence of other documents (such as a Medical Power of Attorney), Wisconsin health care professionals will maintain the patient's nutritional and fluid levels in a coma at a comfortable level for as long as the patient is required to remain in the state of the indefinite vegetative state of unconsciousness.

Step 7: When the Wisconsin Declarant's Executing Signature and Date are disclosed in this procedure, the process is complete and the document is signed.

To carry out this living will in Wisconsin, the patient or Declarant must have two witnesses present at the time of the execution. To be eligible, the Wisconsin Patient/Declarant must fulfill the most stringent requirements, however, there will be some restrictions for all of them. Before signing and dating minimum of two (2) witnesses must be on the paper, he or she must make a mark on the "Signed" and "Dated" blank lines to indicate where the document's initial signature should be placed on the document. Once this form has been completed, the Wisconsin Patient must read it and sign it to certify that it is still in full force and effect. Providing that you fill out the "Date" field next to it, you may use this as your signature. For the reviewers to know when a patient/declarant signed an agreement, it must be clear how long ago they consented to the assertions contained in this document (i.e. Doctors).

It is anticipated that this Party will put his or her home address on the "Address" line and then enter his or her birth date in the "Date Of Birth" box after completing the signature area. It will be feasible to identify the Wisconsin Patient who made the aforementioned comment based on the information that has been provided.

Step 8: Obtain a statement from a witness to determine the validity of the document.

The Wisconsin Declarant must hand over the papers to the present Witnesses before Witness One can sign the first "Witness Signature" line that follows after giving his or her testimony, which begins with "I Believe That The Person Signing..." After Witness One has signed the first "Witness Signature" line, the "Date Signed" date must appear on the document in the same location as the "I Believe That The Person Signing..." date. Second, for Witness One's signature on the Wisconsin Declarant to match the Wisconsin Declarant Signing Date, the signature on the Wisconsin Declarant must be completed as quickly as possible after the Wisconsin Declarant Signature Date is obtained. One of the few ways to verify Witness One's identity is for him or her to fill out the "Print Name" section of the form below with their name.

Upon receiving the signatures of the Wisconsin Patient and the Wisconsin Witness, Witness Two is responsible for acquiring and maintaining ownership of the medical records. Witness Two must read and sign the same testimony as Witness One, using the "Witness Signature" that is still accessible, to be considered trustworthy. When signing the document, the "Date Signed" line must contain the current date, as indicated by the calendar on the right. This document was signed on the same day in Wisconsin by both the Wisconsin Patient/Declarant and Witness One, and the same should be true in this jurisdiction as well.

As a result, Witness One has provided you with a printed form of your name, which you may use to complete the "Print Name" box under your signature.

During this step, compile a list of all of the Wisconsin Directive Keepers.

Fill in the blanks below "****" to allow the Wisconsin Declarant to transmit a list of all parties who have received this document from the Wisconsin Declarant. It is a good idea to include the recipient's name and e-mail address in the Declaration of Independence.

Download our free Wisconsin living will in an instant to create a legally binding document.

Download our free Wisconsin living will in an instant to create a legally binding document.

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