Advance Directive

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? Our Advance Care Planning facilitators can help you start these conversations with your doctor and those close to you.

Another important step that we can help you with is completing an advance directive. A power of attorney for health care is an advance directive. It is a legal document where you can name who you want to make health care decisions for you when you’re unable to make them yourself. We call this individual a health care agent. You are also able to record your health care wishes in the document. Why is this document important? 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 this, your family may need to go through the legal/court system for a legal guardian. This can be time consuming and stressful for the family.

Give the gift of making your health care wishes known to those close to you. We can help you create an advance directive that will give you and those who care about you peace of mind.

Let us help you get started by calling 608-930-7200 extension 3350 or 3351 to schedule an appointment (at no cost to you). The person(s) you are thinking of naming as your health care agent(s) is welcome to join us.


What is Advance Care Planning? (English PDF)
What is the Role of the Health Care Agent? (English PDF)
What is Advance Care Planning and CPR? (English PDF)

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 health care workers
  • Members of a social group or church
  • Bank employees
  • Upland Hills Health Advance Care Planning Facilitators
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 hospital main admissions desk, or 
  • Mail it to
    • Upland Hills Health
      Health Information Management
      800 Compassion Way
      Dodgeville, WI 53533
How often should I review my document?

Plan to review the document when there is a change or decline in your health or every 5 to 10 years.

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 health care agent or give new medical wishes. A new document must also be completed if you are divorced and your spouse was named as a health care agent.

Why Choose Upland Hills Health?

Patient-First Care Every Patient. Every Time.

We are committed to providing the safest and best possible experience for every patient that enters our clinics, our hospital, our nursing and rehab center, our medical equipment store, or who invites us into their home through Home Care or Hospice services.

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