Advance Directives: Forms

Living Will, Power of Attorney forms, Authorization for Final Disposition

To request individual printed copies

You may request individual advanced directive forms by mailing a self-addressed, stamped, business-size envelope to:

Division of Public Health
ATTN: POA
PO Box 2659
Madison WI 53701-2659

Please note which forms you would like to have mailed to you.

Postage: For a single stamp (current rate) you may request the following:

Four Declaration to Physician (Living Will), OR
One Power of Attorney for Health Care, OR
One Declaration to Physician (Living Will) AND one (1) Power of Attorney for Health Care

To request the Power of Attorney for Finances and Property, please mail a self-addressed, stamped envelope with postage of at least $0.69 per form requested.

To request 100 or more printed copies

Forms are available in quantities of 100 or more at a cost of:

$15 per hundred for the Power of Attorney for Health Care
$13 per hundred for the Living Will

Make check payable to DHS, and mail to:

Division of Public Health
ATTN: POA
PO Box 2659
Madison WI 53701-2659


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

Assigned Number Title Sort descending Division Language Release Date File Type Available to Order
F-00086 Authorization for Final Disposition (PDF) DPH English 05/2010 PDF
F-00086H Authorization for Final Disposition (PDF), Hmong DPH Hmong 05/2010 PDF
F-00086S Authorization for Final Disposition (PDF), Spanish DPH Spanish 05/2010 PDF
F-00060 Declaration to Physicians (Living Will) DPH English 02/2020 PDF
F-00060H Declaration to Physicians (Living Will), Hmong DPH Hmong 02/2020 PDF
F-00060PA Declaration to Physicians (Living Will), Pashto DPH Pashto 02/2020 PDF
F-00060S Declaration to Physicians (Living Will), Spanish DPH Spanish 02/2020 PDF
F-00036 Power of Attorney for Finance and Property DPH English 10/2024 PDF
F-00036H Power of Attorney for Finance and Property, Hmong DPH Hmong 10/2024 PDF
F-00036S Power of Attorney for Finance and Property, Spanish DPH Spanish 10/2024 PDF
F-00085 Power of Attorney for Health Care - Letter and Form DPH English 02/2020 PDF
F-00085CM Power of Attorney for Health Care - Letter and Form, Chinese (Simplified) DPH Chinese (Simplified) 02/2020 PDF
F-00085H Power of Attorney for Health Care - Letter and Form, Hmong DPH Hmong 02/2020 PDF
F-00085KA Power of Attorney for Health Care - Letter and Form, Karen DPH Karen 02/2020 PDF
F-00085PA Power of Attorney for Health Care - Letter and Form, Pashto DPH Pashto 02/2020 PDF
F-00085S Power of Attorney for Health Care - Letter and Form, Spanish DPH Spanish 02/2020 PDF
F-00085V Power of Attorney for Health Care - Letter and Form, Vietnamese DPH Vietnamese 02/2020 PDF

Glossary

 
Last revised July 2, 2024