Wisconsin Medical Power of Attorney (Form F-00085)

The Wisconsin Medical Power of Attorney (Form F-00085) is a form that any adult “who is of sound mind” may execute. This adult (the “Principal”), can complete it for the purpose of designating an Agent who will represent them as well as their healthcare wishes if they become incapacitated. As they will be incapable of monitoring their Agent if this happens, the importance of selecting a responsible and trustworthy Agent cannot be stressed enough. Likewise, it is equally vital that the implications of executing this document are appreciated. In the words of the Department, “Do not sign it until you, and your chosen Agent, understand the powers being granted.”

Additional Considerations

State law mandates that the Principal’s incapacity may only be determined by medical professionals. Specifically, the instructions the State of Wisconsin, Department of Health Services provides in Form F-00085 state that “incapacity” exists if two (2) physicians or a physician and a psychologist who have personally examined the Principal sign a statement that specifically expresses their opinion that they have a condition that renders them incapable of receiving and evaluating information effectively or communicating decisions to such an extent that they lack the capacity to manage their own health care decisions.

Once such a determination has been recorded in a statement, a copy of it must be attached to the Advance Healthcare Directive.

State Laws & Signing Requirements

State Laws – Power of Attorney for Health Care

Signing Requirements (§ 155.110) – The following mandatory requirements, as quoted from state law, must be attended to by a Principal in the state of Wisconsin in order to render their Power of Attorney for Health Care valid. The document must be:

  • In writing,
  • Dated and signed by the Principal or by an individual who has attained age 18, at the express direction and in the presence of the Principal,
  • Signed in the presence of 2 witnesses who meet the requirements of sub. (2), and
  • Voluntarily executed.