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Notice of Rights Prior to Examination by Physician or Psychologist Wisconsin Form

Q: What is the 'Notice Of Rights Prior To Examination By Physician Or Psychologist Wisconsin'?

The 'Notice Of Rights Prior To Examination By Physician Or Psychologist Wisconsin' is a legal document that informs individuals of their rights before undergoing an examination by a physician or psychologist. This notice ensures that patients are aware of their rights regarding consent and confidentiality, which is crucial for their protection and peace of mind.

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STATE OF WISCONSIN, CIRCUIT COURT, COUNTY For Official Use IN THE MATTER OF Amended Notice of Rights Prior to Examination by Physician or Psychologist Date of Birth Case No. I am a physician/psychologist. I have been requested to examine you and submit a report of my professional opinion of your need for a guardian. The physician-patient privilege and psychologist-patient privilege relating to confidential communications does not apply. Prior to the examination on which my report will be based, you need to be informed that: 1. Statements that you make may be used as a basis for a finding of incompetency. 2. You have the right to refuse to participate in the examination (in the absence of a court order requiring your participation) or speak to me. 3. I am required to report to the court even if you do not speak to me. By providing you with notice of these rights, there is a presumption that you understand that you do not need to speak to me. After the examination has been completed, I will submit a written report to the court stating my opinion on the presence and likely duration of any medical or other condition that may be causing you to have incapacity and on your need for a guardian. My report will also state my opinion of the extent that any incapacity affects your ability to exercise specific rights and the extent of any powers recommended to be transferred to a guardian. Proof of Informing Individual of Rights Prior to Examination I state that on (date) at (place) a nd prior to examination of the individual, I informed the individual of the above rights. Signature of Examiner Name Printed or Typed Address Name of Attorney Address Telephone Number Bar Number GN-3125, 10/06 Notice of Rights Prior to Examination by Physician/Psychologist §54.36, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

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Fill and Sign the Notice of Rights Prior to Examination by Physician or Psychologist Wisconsin Form