The Kansas Advance Directive is the recommended document to complete for those looking to prioritize their future medical care. When an individual enters a state where they are unable to convey their preferences concerning healthcare decisions, it can cause a bit of disarray as to what the patient’s wishes would have been. This form essentially enables the principal/declarant to describe what is to transpire should they be in a life-threatening situation as well as to assign a third-party representative to make any other choices on their behalf. To fulfill the obligations of this written instrument, executors will need to provide the name of their agent, healthcare preferences, and signature in each designated portion of the form that is to be acknowledged by two (2) witnessing parties or a notary public.
Parties interested in being enrolled in the state’s organ donation program should visit the Donate Life Kansas Website to register.
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