Free Kansas Living Will Form

Signing Requirements and Laws

Kansas living wills, called declarations under state law, are governed by Kan. Stat. Ann. § 65-28,103. The declaration must be signed by the declarant, or by someone else in the declarant’s presence and at the declarant’s direction. Its execution must then be attested either by two witnesses or by a notary public.^[1]

• Witnesses. The declaration is signed in the presence of two or more witnesses who are at least 18 years of age.^[1]
• Independence. A witness cannot be the person who signed on the declarant’s behalf, cannot be related to the declarant by blood or marriage, and cannot be entitled to any part of the declarant’s estate under intestate succession or under a will or codicil.^[1]
• No financial interest. A witness also cannot be directly financially responsible for the declarant’s medical care.^[1]
• Notarization. Instead of two witnesses, the declaration may be acknowledged before a notary public.^[1]

Under K.S.A. § 65-28,104, you may revoke your declaration at any time by destroying it, by a signed and dated written revocation, or by a verbal statement made in front of a witness who is 18 or older and who signs and dates a writing confirming it. A verbal revocation takes effect when your attending physician receives that writing.^[2]

Any adult may sign a Kansas declaration (K.S.A. § 65-28,103(a)).^[1]

Kansas Rules for After You Sign the Declaration

Three rules from Kan. Stat. Ann. § 65-28,103 govern the declaration once it is signed, covering who must be told about it, where it is kept, and when it does not apply.^[1]

• Notify your physician. It is the declarant’s responsibility to notify their attending physician that the declaration exists, since the document only works if the treating doctor knows about it.^[1]
• Medical records. Once an attending physician is notified, that physician must make the declaration, or a copy of it, part of the declarant’s medical records, so the wishes it states travel with the declarant’s chart.^[1]
• Pregnancy exception. If a physician has diagnosed the declarant as pregnant, the declaration has no effect during the pregnancy, regardless of what it says.^[1]

These forms only protect the declarant’s wishes if the people who need to see them can find them. Give a signed copy to the attending physician, keep the original in an accessible place, and let close family members know where to find it.

Kansas Living Will Form Details

Does a Living Will in Kansas Require the Declarant’s Signature?

Yes. Kansas law requires the declaration to be signed by the declarant, or by another person in the declarant’s presence and at the declarant’s expressed direction.^[1] This signature requirement applies no matter which template you use to prepare the document.

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Living Will vs. Power of Attorney in Kansas

A living will only states your own wishes for end-of-life care. A medical power of attorney goes further and names a person, called your agent, to make health care decisions for you. That agent can act whenever you cannot decide for yourself, not only at the end of life.

The Kansas living will form on this page combines both documents. You get a declaration of your wishes and, if you fill in the agent section, a medical power of attorney in the same form.

Steps to Fill Out the Form

The Kansas living will form on this page combines a declaration on end-of-life care with an optional medical power of attorney naming a health care agent. Follow the steps below in order, using the page numbers to find each part of the form.

1. Complete the Declaration (page 2). Fill in the date and your full name and address. You can use FormsPal’s online PDF editor to fill in these fields digitally before printing.
2. Initial Your Health Care and End-of-Life Care Wishes (page 2). Initial each item describing the treatments and conditions that reflect your wishes.
3. Add Additional Instructions (Optional) (page 3). Write any further wishes on the blank lines, or leave this section blank.
4. Name Your Health Care Agent (page 3). Enter the name, address, and phone number of the person you want to make medical decisions for you.
5. Name a Substitute Agent (page 4). Enter the name, address, and phone number of a backup agent in case your first choice cannot serve.
6. Review the Powers Granted to Your Agent (page 4). Read the listed powers your agent will hold. Because this section is long, you can use FormsPal’s chat-with-PDF tool to ask questions about it before you sign.
7. Review the Standard Provisions (page 6). Read the items covering the effective date, HIPAA release, conservator nomination, revocation, and governing law. No entries are needed here.
8. Sign and Date the Declaration (page 8). Sign, print your name, and date the declaration.
9. Sign Before Two Witnesses (page 8). Have two eligible witnesses complete and sign the acknowledgment.^[1]

After signing, give copies to your physician, your named health care agent, and any close family members who should know your wishes.

Other Kansas Forms
Below are various other Kansas templates completed by our users. Try our simple builder to customize these forms to your preferences.

Kansas Last Will Kansas Small Estate Affidavit Kansas Bill of Sale Kansas Power of Attorney Kansas Eviction Notice Kansas Promissory Note Kansas Non-compete Agreement Kansas Prenuptial Agreement Kansas LLC Operating Agreement

General information, not legal or tax advice.

Sources

1. Kan. Stat. Ann. § 65-28.
2. Kan. Stat. Ann. § 65-28,104.

Mara Erlach

Writer & Attorney

Mara has been practicing estate planning and trust law in California since 2003, taking pride in helping clients of all backgrounds and asset profiles form a complete and customized estate plan. Her specialties are: estate planning, wills and trusts, trust and probate administration.