You and your doctor talk about your test results, medications and other important health care matters. If you were unable to talk with your doctor due to a sudden illness or accident, would your doctor know your future health care wishes? Do those closest to you know your wishes? We can help you start these conversations with your doctor and those close to you.
Why complete an Advance Directive?
• Wisconsin is not a next of kin state, meaning family members are not automatically granted the right to make health care decisions for you.
• Without one, your family may need to go through the legal/court system for a legal guardian. This can be costly, time-consuming and stressful.
• It will give you and your family peace of mind.
What is an Advance Directive?
• It is a legal document.
• You can name who you want to make your health care decisions for you when you are unable to do so.
• You can write down your health care wishes so your doctors and family know your wishes.
Does my health care agent have to live close by?
No. Be sure to have up to date phone numbers listed, so the health care team can contact your health care agent.
How does an advance directive document become legal?
The document must be signed and dated by you in the presence of 2 witnesses. The witnesses must sign on the same day as you.
Who can be a witness?
Witnesses must be at least 18 years of age.
Here is a sample listing of individuals who may serve as a witness:
- Friends
- Neighbors
- Co-workers, as long as they are not healthcare workers
- Members of a social group or church
- Bank employees
- Upland Hills Health Patient and Family Services
When my Power of Attorney for Health Care document is complete, what do I do with it?
Give a copy to each health care agent, your doctor’s office and hospital. Keep the original in a close place where you can find it at any time. If you are an Upland Hills Health patient, you can:
- Fax it to 608.930.7261, attention Health Information Management
- Drop off a copy to the clinic or at hospital main admissions desk, or
- Mail it to
- Upland Hills Health
Health Information Management
800 Compassion Way
Dodgeville, WI 53533
- Upland Hills Health
What should I do if I need to make changes to the document?
You may need to make changes to the document. Some are simple changes, like a new phone number or address for you or a health care agent. These changes along with your name and date of birth can be sent to:
Upland Hills Health
Health Information Management
800 Compassion Way
Dodgeville, WI 53533
You must complete a new document when you want to name a new healthcare agent or give new medical wishes. A new document must also be completed if you are divorced and your spouse was named as a healthcare agent.
