Kansas Medical Power of Attorney Form [PDF]

Authorize your agent or attorney-in-fact to make healthcare decisions on your behalf by drafting the Kansas medical power of attorney.

Last update: 27 Mar 2024

Kansas Medical Power of Attorney Form [PDF]

The Kansas medical power of attorney, or healthcare power of attorney, is a legal document that gives your agent or the attorney-in-fact the authority to make decisions about your healthcare in case you are unable to do so.

The Kansas medical power of attorney form can include various preferences about the principal’s healthcare. 

They can outline all the treatments and medications they want or don’t want to be subjected to and provide their agent’s scope of authority by setting the medical power of attorney rights and limitations.

Laws and Legal Requirements for a Medical Power of Attorney in Kansas

Laws and Legal Requirements

Chapter 58, Article 6 of the Kansas statutes regulates the status of the Kansas medical power of attorney.

§58-629 of the Kansas statutes provides that the principal should sign the document before at least two witnesses and a notary public. The witnesses should be at least 18 years old.

§58-657 provides that you can revoke your medical power of attorney by notifying your healthcare professional about your intention to revoke it. You can also make a revocation by issuing a written revocation, as well as set the power of attorney termination date when issuing it.

How to Write a Medical Power of Attorney in Kansas

Here, you can see the step-by-step process of writing the Kansas medical power of attorney.

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

Here, you will find the Kansas medical power of attorney template. First, you have to fill it out with the relevant information about the principal. You should enter their full name, mailing address, and contact details. In this section, you should also enter the date the medical power of attorney is issued.

Our advanced legal document builder will guide you through the whole process by providing all the relevant information on how to fill out the medical power of attorney form.

#2. Appoint a Healthcare Representative

This section should include the basic details about your attorney-in-fact. You should enter their full name, mailing address, and contact details. 

You should find someone of legal age and with the legal capacity to be appointed. The agent will be authorized to represent you within the framework of the medical power of attorney rights and limitations.

The agent or attorney-in-fact should be a person who is both willing and capable of representing you. However, it should also be someone you can trust, considering that they will have important authority over your healthcare. This can be your spouse, your relative, your friend, or a trusted advisor.

#3. Identify an Alternative Healthcare Representative

The alternative healthcare representative, also called the secondary agent, will act only if the primary healthcare representative is not able to represent the principal. They have the same scope of authority and should fulfill the same requirements as the primary healthcare representative.

You can appoint one, two, or more people as your secondary agents. This is a good way to secure the execution of your preferences, even if some of your agents cannot represent you.

#4. Identify the Witnesses and Have Them Sign the Form

After finalizing your medical power of attorney form, you should sign it before at least two witnesses.

The following persons are not eligible to serve as a witness:

  • Principal’s agent

  • Principal’s blood relative

  • People married or adopted by the principal

  • People entitled to any portion of the estate of the principal

  • People who are directly financially responsible for the principal's healthcare

#5. Notarize the Form

Finally, you should have the notary public acknowledge your witnesses and your signature. This will provide additional authenticity for the document and prevent potential fraud.

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