Kansas Health Care Power of Attorney Form


A Kansas durable health care power of attorney is a form that allows an individual (the principal) to appoint a person to act as their agent for health care decisions. The agent only has this power if the principal becomes incapacitated or dies. This form allows the agent to consent, refuse consent, or withdraw consent to care and treatments on behalf of the principal. It also enables them to make necessary arrangements with health care providers and decisions about organ donation or autopsy (§ 58-632). As long as the principal is mentally sound, they can cancel the agreement at any time. If they wish to make changes, they must fill out a new form as they cannot edit the original.

The agent can use this form to make choices that will positively impact the principal’s physical, mental, and emotional well-being. Once active, the agent can make the following decisions for the principal:

  • Hospital (including psychiatric care or treatment), nursing home, or living situation;
  • Hire or fire a health care team (i.e., physicians, psychologists, psychiatrists, nurses, dentists, therapists, etc.); and/or
  • Release or review the principal’s medical history and records to their health care team.

Laws: § 65-28,103§ 58-625 and § 58-632

Signing requirements (§ 65-28,103(a)(4) and § 58-629(e)): Must be witnessed by two (2) witnesses or acknowledged by a Notary Public.