Kansas Durable Medical Power of Attorney Form

Kansas durable medical power of attorney for health care form lets the principal select another person called the `Agent` to facilitate of the patient`s health care wishes. This facilitation becomes effective when the principal wishes and is devised for the the event that they become no longer able to make these decisions themselves. It applies with reference to § 65-28,103§ 58-632, and it requires a notary or two witnesses. The document is legally binding in the state of Kansas.

How to Write

Durable Power Of Attorney For Health Care Decisions

The principal and agent must enter their personal details.

  • Name of principal.
  • Name of agent.
  • Address of agent.
  • Telephone number of agent.

Statement Of Principal`s Desires

The principal must enter specific details of any other instructions to the agent regarding their health care treatment.


Limitations Of Authority

2) The principal should list the specific items for which the agent is restricted from authorizing consent for.

3) The principal should enter any other specific limitations regarding the power of attorney for health care decisions.



Execution Of Power Of Attorney

The details for execution of the power of attorney must be entered.

  • Date.
  • Address.
  • Signature of principal.



The personal details of the notary or two witnesses must be entered.

  • Names of witnesses.
  • Addresses of witnesses.
  • State of notary.
  • County of notary.
  • Date.
  • Name of notary.
  • Signature of notary.
  • Seal (if available).
  • Expiration date of notary.