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This Document Contains:
Laws
Statutes – Medical POA (§ 58-625 – § 58-632), Living Will (§ 65-28,101 – § 65-28,109)
Definitions – § 58-625, § 65-28,102(b)
Signing Requirements – Both sections of the form must receive the acknowledgment of two (2) witnesses or a notary public (§ 58-629(e), § 65-28,103(a)(4)).
Other Versions (10)
- AARP
- Five Wishes (Aging with Dignity)
- HaysMed
- Kansas Health System
- Kansas State University
- LMH Health
- Prepare for Your Care
- Spanish/Español
- The Archdiocese of Kansas City in Kansas
- Wichita Medical Research & Education Foundation (WMREF)
Download: Adobe PDF
Instructions: Adobe PDF
Five Wishes (Aging with Dignity) Version
(may only be in addition to one of the other state-approved copies of the form)
Download: Adobe PDF
Information: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Kansas State University Version
Download: Adobe PDF
Download: Adobe PDF
Prepare for Your Care Version (also available in Spanish/en Español)
Download: Adobe PDF
Download: Adobe PDF
The Archdiocese of Kansas City in Kansas Version
Download: Adobe PDF
Wichita Medical Research & Education Foundation (WMREF)
Download: Adobe PDF
Additional Resources
- Donate Life Kansas – Organ, Eye, and Tissue Donor Registry Information
- Kansas Bar Association – Living Will Information
- Kansas Legal Services – Advance Directives Handout
- Kansas State University – Advance Health Care Planning
- Kansas State University – Do Not Resuscitate Directives
- LMH Health – Advance Directives Guide
- The Archdiocese of Kansas City in Kansas – Advance Directive Guide
- United Healthcare – Advance Directives Handout
- WMREF – Choosing an Agent
- WMREF – Kansas Advance Directives FAQ
- WMREF – Kansas Advance Directives Pamphlet
- WMREF – Life-Sustaining Treatments (also available in Spanish/en Español)
- WMREF – Make the Decision Yours
- WMREF – Medically Assisted Nutrition and Hydration
- WMREF – Understanding Do-Not-Resuscitate (also available in Spanish/en Español)
Related Forms (6)
- Advance Directive Wallet Cards
- Do-Not-Resuscitate (DNR) Directive
- Durable (Financial) Power of Attorney
- HIPAA Privacy Authorization Form
- Organ Donation Form
- Transportable Physician Orders for Patient Preferences (TPOPP) Form
Advance Directive Wallet Cards
Download: Adobe PDF
Do-Not-Resuscitate (DNR) Directive
Download: Adobe PDF (also available in Spanish/en Español)
Laws: § 65-4941 – § 65-4948
Durable (Financial) Power of Attorney
Download: Adobe PDF, MS Word (.docx)
HIPAA Privacy Authorization Form
Download: Adobe PDF
Download: Adobe PDF
Transportable Physician Orders for Patient Preferences (TPOPP) Form
Download: Adobe PDF
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