Skip to Content


Count...

on Dean for unparalleled patient care and customer service.

Advance Directives

Important documents for every patient.

As part of good medical care for you and your family, it’s important for all patients to have advance directive documents on file with Dean Clinic.

An advance directive is a legal document that states how you want your health care decisions to be made if you become incapacitated or if you cannot express your wishes. An advance directive helps guide your doctor and your loved ones about the care you wish to receive.

Both the Power of Attorney for Health Care and the Declaration to Physicians, when properly completed and signed, are essential parts of good planning and medical care. They not only help physicians, family and friends honor your wishes, but also relieve the pressure of decision-making at a potentially stressful time.

Power of Attorney for Health Care 

How to Complete Advance Directive Forms

The most important document is a Power of Attorney for Health Care form, which allows you to appoint an agent who will make treatment decisions on your behalf if you lose the ability to do so.

Your agent should be someone who is at least 18 years of age, and who knows your values and wishes. He or she must be willing to to make decisions that are consistent with your wishes, and communicate those wishes to the health care team. Your agent is usually a spouse, trusted relative or friend.

A Power of Attorney for Health Care document can also include an addendum to specify your treatment preferences.

Declaration to Physicians (Living Will)

A Declaration to Physicians spells out the types of medical treatments and life-sustaining measures you would or would not want if you had a terminal condition or were in a persistent vegetative state. While this document does not authorize anyone to make decisions on your behalf, it does indicate the types of treatment (or lack of treatment) you would want. This is especially important if you do not have a power of attorney for health care or your agent is unavailable.

If you have both a Declaration to Physicians and a Power of Attorney for Health Care, be sure they are consistent. If there is any conflict between the two, the Power of Attorney for Health Care will overrule the Declaration to Physicians.


How to Prepare Your Form(s)

To complete a Power of Attorney for Health Care form and a Declaration to Physicians, as well as other advance directives forms of your choosing, follow these steps:

  • Click the link in the box to the upper right to download the form from the State of Wisconsin.
  • Complete the Power of Attorney for Health Care and/or Declaration to Physicians forms, sign the forms, have your agent sign the forms, and have witnesses sign. You do not need an attorney to complete advance directive forms; however, you may wish to consult with an attorney.
  • After you complete and sign the forms, mail copies for inclusion in your medical records. Alternatively, you can give copies of the form(s) directly to your doctor.

    Dean Clinic Central Storage
    Health Information
    PO Box 259840
    Madison, WI 53725
  • Be sure to discuss your wishes with your proxy so that your intentions are clear.

Remember, completed advance directives should be kept in TWO places:

  • Safely stored with your other legal documents in an accessible place or with your attorney;
  • On file with your doctor, as part of your medical record. Some people choose to make and carry a wallet card which indicates where these forms are located and/or the name and contact information of their attorneys.

With your signed and completed advance directives forms on file, you can be assured your wishes regarding health care will be respected.


What Should I Do If I Can't Open the Form? 

If you can't open the form in the box to the right, you may request up to two forms free of charge by sending a stamped, self-addressed business-sized envelope to the Wisconsin Department of Health & Human Services:

Power of Attorney 
Division of Public Health
PO Box 2659
Madison, WI 53701-2659 

Important Details

  • You may state in the Power of Attorney for Health Care any types of health care that you do or do not desire.
  • You may limit the authority of your health care agent.
  • You may indicate an alternate health care agent if your primary agent is ever unable or unwilling to make decisions for you.
  • If you have appointed an agent for Power of Attorney for Finance and Property, this person does not have the authority to make health care decisions on your behalf, unless you have also appointed them as agent for Power of Attorney for Health Care. It is common for people to appoint one agent for health care decisions and another agent to handle financial matters.
  • If you also have a valid Declaration to Physicians (Living Will), the Power of Attorney for Health Care supercedes any conflicting directives in the living will. In other words, your agent has the authority to make a different decision from your Declaration to Physicians/Living Will, if the declaration does not match what they understand to be your treatment preferences and wishes. You should be sure that the person you appoint as your agent is someone you trust and who will always honor your wishes.
  • Two physicians, or a physician and a psychologist, must declare that you no longer have capacity to make decisions for yourself (e.g. a persistent vegetative state or lost mental capacity), before your agent can make decisions on your behalf.

Easy Access to Your Family Member's Medical Record

If you are the caregiver of an adult family member, MyChart gives you online access to that person's medical record, lab results and other information. Learn more.

Related Resources

Free Power of Attorney for Health Care Class at St. Mary's Hospital

St. Mary's Hospital in Madison holds free one-hour sessions every Monday, from 12:30-1:30 pm, to help you organize and prepare legal medical documents.

Call St. Mary's Care Management department at (608) 258-6561 if you have questions. More information is also available on St. Mary's website.