Kansas Living Will Form (Advance Directive)

The Kansas Advance Health Care Directive which is also known as a ‘Living Will’ provides the option to choose what medical treatment they receive if they can no longer convey their wishes due to severe illness, in cases such as Unconsciousness or Dementia. The document is created with respect to § 65-28,103§ 58-632. The Kansas advanced health care directive requires at least two witnesses or a notary.

How to Write

Living Will Declaration

The principal must carefully read the document and then complete the relevant blank fields.


The Principal

The principal must enter their personal details.

  • Date.
  • Name of principal.
  • Signature of principal.
  • Address of principal.



The details of a notary or two witnesses must be entered.

  • Signatures of witnesses.
  • State of notary.
  • County of notary.
  • Date.
  • Name of notary.
  • Signature of notary.
  • Seal (If available).
  • Expiration date of notary.



The principal can enter any other details they feel relevant to this Living Will document.