Kansas Advance Directive Form

Last updated September 29th, 2021

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The Kansas advance directive form is a document that is used by the principal to prepare for their end-of-life medical care by executing a living will and assigning a health care agent. In the living will, the principal declares their wish to have medical treatments withheld and withdrawn if they are in a terminal condition. The health care agent is a trusted individual who is given the power of attorney to make medical decisions for the principal if they are incapacitated. By completing this form, the principal ensures that their convictions and wishes will be respected in the event of their incapacity.

Agent’s DutiesK.S.A 58-629(b) and (c)

Laws – K.S.A. 65-28,103, 58-625 and 58-632

Signing Requirements (K.S.A. 65-28,103(a)(4) and 58-629(e)) – Two (2) Witnesses or Notary Public; witnesses must be at least eighteen (18) years of age and cannot be any of the following:

  • The health care agent named in the document;
  • The person who signed on behalf and at the direction of the principal;
  • Related to the principal by blood, marriage, or adoption;
  • Entitled to any part of the principal’s estate; or
  • Financially responsible for the principal’s medical care.

Statutory FormsK.S.A. 65-28,103(c) and 58-632

Related Forms

Living Will – Communicates the principal’s preference to have life-sustaining treatments withdrawn if they are in a terminal condition.

Download: PDF


Medical Power of Attorney – Appoints an agent who is given the power of attorney to make decisions regarding the principal’s health care if they are incapacitated.

Download: PDF