Advance Directives: Forms

When printing the form, please be sure you print and complete all pages of the form you are using. To be valid, the form must be complete and signed. Wisconsin Stat. ch. 154 - Advance Directives.

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Assigned number	Title Sort descending	Division	Language	Release date	Available to order
F-00086	Authorization for Final Disposition (PDF)	DPH	English	05/2010	No
F-00060	Declaration to Health Care Professionals (Living Will) (PDF)	DPH	English	02/2020	No
F-03435	Medical Certification of Capacity for Determining a Patient’s Representative Authority to Act (PDF)	DPH	English	06/2026	No
F-03436	Patient’s Representative Declaration (PDF)	DPH	English	06/2026	No
F-00036	Power of Attorney for Finance and Property (PDF)	DPH	English	10/2024	No
F-00085	Power of Attorney for Health Care - Letter and Form (PDF)	DPH	English	02/2020	Yes
F-00085LP	Power of Attorney for Health Care - Letter and Form, Large Print (PDF)	DPH	English	02/2020	No
F-00085CM	Power of Attorney for Health Care - Letter and Form, Chinese (Simplified) (PDF)	DPH	Chinese (Simplified)	02/2020	Yes
F-00086H	Authorization for Final Disposition, Hmong (PDF)	DPH	Hmong	05/2010	No
F-00060H	Declaration to Health Care Professionals (Living Will), Hmong (PDF)	DPH	Hmong	02/2020	No
F-03435H	Medical Certification of Capacity for Determining a Patient’s Representative Authority to Act, Hmong (PDF)	DPH	Hmong	06/2026	No
F-03436H	Patient Representative Declaration, Hmong (PDF)	DPH	Hmong	06/2026	No
F-00036H	Power of Attorney for Finance and Property, Hmong (PDF)	DPH	Hmong	10/2024	No
F-00085H	Power of Attorney for Health Care - Letter and Form, Hmong (PDF)	DPH	Hmong	02/2020	Yes
F-00085KA	Power of Attorney for Health Care - Letter and Form, Karen (PDF)	DPH	Karen	02/2020	Yes
F-00060PA	Declaration to Health Care Professionals (Living Will), Pashto (PDF)	DPH	Pashto	02/2020	No
F-00085PA	Power of Attorney for Health Care - Letter and Form, Pashto (PDF)	DPH	Pashto	02/2020	Yes
F-00086S	Authorization for Final Disposition, Spanish (PDF)	DPH	Spanish	05/2010	No
F-00060S	Declaration to Health Care Professionals (Living Will), Spanish (PDF)	DPH	Spanish	02/2020	No
F-03435S	Medical Certification of Capacity for Determining a Patient’s Representative Authority to Act, Spanish (PDF)	DPH	Spanish	06/2026	No
F-03436S	Patient Representative Declaration, Spanish (PDF)	DPH	Spanish	06/2026	No
F-00036S	Power of Attorney for Finance and Property, Spanish (PDF)	DPH	Spanish	10/2024	No
F-00085S	Power of Attorney for Health Care - Letter and Form, Spanish (PDF)	DPH	Spanish	02/2020	Yes
F-00085V	Power of Attorney for Health Care - Letter and Form, Vietnamese (PDF)	DPH	Vietnamese	02/2020	Yes

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