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Kansas Durable Power of Attorney for Health Care Decisions

The statutory model lets the principal specify immediate authority or an incapacity trigger; select the intended timing rather than leaving the alternatives unresolved.

Jurisdiction
Kansas
Purpose
Medical & health care
Source / form version
Undated legacy PDF; current guide also points to Judicial Council December 2025 forms
Resource format
PDF
Signing
Date and sign using two eligible adult witnesses, or acknowledge before a notary. Witnesses cannot be the agent, specified relatives, heirs or people responsible for health care costs.
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Sources checked: 2026-11-13. General information, not individual legal advice.

Use the medical appointment

Kansas Legal Services hosts this three-page statutory-form PDF. It covers an agent’s treatment decisions, arrangements with care facilities and access to information. Its current guide also directs readers to the Judicial Council’s newer health care document. The PDF here is a separate legacy resource, not a relabelled copy of the newer Council form.

Sources: [2] [3] [4] [5]

Resolve the timing and instructions

The model includes alternative effective-time wording and a space for special directions. Read these choices with the person who would act. Under K.S.A. 58-629, the default depends on attending-physician-determined impairment unless the power specifically says otherwise. An agent must follow your expressed wishes and cannot invalidate an existing living-will declaration.

Sources: [2] [3] [4] [5]

Choose an eligible signing route

Two qualified adults or a notary can complete execution. A witness cannot be the agent, a relative, an heir or someone financially responsible for your care. Certain providers and facility personnel cannot be agents unless a statutory exception applies. Keep the signed instrument accessible and share it with the agent and care team. Complete the same version throughout and retain the execution pages with the appointment. Ask the selected agent to keep a copy that can be found during treatment.

Sources: [2] [3] [4] [5]

Common questions

Must the health agent be a relative?

No. Choose someone eligible, willing and able to follow your wishes. Provider and facility relationships have separate restrictions.

Sources: [2] [3] [4] [5]

Can this replace a financial power?

No. This document is for health care. The general durable financial appointment is a separate instrument.

Sources: [2] [3] [4] [5]

Related forms and guides

Sources and verification

  1. Kansas Legal Services — statutory-form PDF: source and instructions (opens in a new tab)
  2. Published form (opens in a new tab)
  3. K.S.A. 58-629, authority and execution (opens in a new tab)
  4. K.S.A. 58-632, statutory medical form (opens in a new tab)
  5. Kansas Judicial Council current forms (opens in a new tab)

Legacy KLS PDF downloaded and inspected, 3 pages with AcroForm fields. Current KLS guide now points to Judicial Council; the still-hosted file has not been described as a new 2025/2026 revision. Compared its appointment and signing provisions with current §§58-629 and 58-632, including notary-or-two-eligible-witnesses, default incapacity trigger and statutory limits; no newer edition or individualized validity guarantee claimed.

The date above records a source check. It does not certify that a form is suitable for your circumstances or that an attorney has reviewed your document. Read the publisher’s current instructions before use.