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.
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
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.
| 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 | No | |
| F-00086H | Authorization for Final Disposition (PDF), Hmong | DPH | Hmong | 05/2010 | No | |
| F-00086S | Authorization for Final Disposition (PDF), Spanish | DPH | Spanish | 05/2010 | No | |
| F-00060 | Declaration to Physicians (Living Will) | DPH | English | 02/2020 | No | |
| F-00060H | Declaration to Physicians (Living Will), Hmong | DPH | Hmong | 02/2020 | No | |
| F-00060PA | Declaration to Physicians (Living Will), Pashto | DPH | Pashto | 02/2020 | No | |
| F-00060S | Declaration to Physicians (Living Will), Spanish | DPH | Spanish | 02/2020 | No | |
| F-00036 | Power of Attorney for Finance and Property | DPH | English | 08/2016 | No | |
| F-00036H | Power of Attorney for Finance and Property, Hmong | DPH | Hmong | 08/2016 | No | |
| F-00036S | Power of Attorney for Finance and Property, Spanish | DPH | Spanish | 08/2016 | No | |
| F-00085 | Power of Attorney for Health Care - Letter and Form | DPH | English | 02/2020 | Yes | |
| F-00085CM | Power of Attorney for Health Care - Letter and Form, Chinese (Simplified) | DPH | Chinese (Simplified) | 02/2020 | Yes | |
| F-00085H | Power of Attorney for Health Care - Letter and Form, Hmong | DPH | Hmong | 02/2020 | Yes | |
| F-00085KA | Power of Attorney for Health Care - Letter and Form, Karen | DPH | Karen | 02/2020 | Yes | |
| F-00085PA | Power of Attorney for Health Care - Letter and Form, Pashto | DPH | Pashto | 02/2020 | Yes | |
| F-00085S | Power of Attorney for Health Care - Letter and Form, Spanish | DPH | Spanish | 02/2020 | Yes | |
| F-00085V | Power of Attorney for Health Care - Letter and Form, Vietnamese | DPH | Vietnamese | 02/2020 | Yes |