Overview
The Kansas Medical Power of Attorney form serves as a crucial document for individuals wishing to designate a trusted person to make healthcare decisions on their behalf in the event they become unable to communicate their wishes. This form empowers the appointed agent to act in the best interest of the principal, ensuring that medical treatment aligns with their values and preferences. It covers key aspects such as the scope of authority granted to the agent, including decisions regarding medical procedures, treatment options, and end-of-life care. Additionally, the form allows for specific instructions or limitations that the principal may wish to impose on their agent’s decision-making powers. By completing this document, individuals can ensure that their healthcare choices are respected, even when they cannot voice them directly. Understanding the importance of this form can help families navigate difficult medical situations with clarity and confidence.
Document Sample
Kansas Medical Power of Attorney
This document grants power to a trusted individual to make medical decisions on behalf of the person creating the document (the "Principal") in the event that the Principal is unable to make decisions for themselves. The powers granted herein are to be used in accordance with the laws of the State of Kansas, including, but not limited to, the Kansas Natural Death Act.
Principal’s Information
Full Name: ___________________________
Date of Birth: ________________________
Address: ______________________________
_______________________________________
Agent’s Information
Full Name: ___________________________
Date of Birth: ________________________
Address: ______________________________
_______________________________________
Phone Number: _________________________
Email Address: ________________________
Alternate Agent’s Information (Optional)
Full Name: ___________________________
Date of Birth: ________________________
Address: ______________________________
_______________________________________
Phone Number: _________________________
Email Address: ________________________
The Principal designates the above-named Agent to make health care decisions on their behalf as authorized in this document. If the primary Agent is unable or unwilling to serve, the Principal designates the above-named Alternate Agent as their successor.
Scope of Authority
The Agent is authorized to make a wide range of health care decisions for the Principal. This may include, but is not limited to:
- Selection or change of medical care providers.
- Approval or disapproval of diagnostic tests, surgical procedures, and programs of medication.
- Directions to provide, withhold, or withdraw artificial nutrition and hydration, and all other forms of health care, including life-prolonging interventions.
The Agent’s authority is effective immediately upon the incapacitation of the Principal and will remain in effect unless the Principal specifies an expiration date or conditions under which it will terminate.
Signatures
This document must be signed by the Principal in the presence of two witnesses, who must also sign. The witnesses cannot be the Agent or Alternate Agent.
Principal’s Signature: ______________________________ Date: ___________
Witness 1 Signature: _______________________________ Date: ___________
Witness 2 Signature: _______________________________ Date: ___________
Agent’s Acceptance
I, the undersigned, accept the appointment as Agent or Alternate Agent (as applicable) and agree to act in accordance with the wishes of the Principal and the laws of Kansas.
Agent’s Signature: _________________________________ Date: ___________
Alternate Agent’s Signature: _________________________ Date: ___________
This form does not replace legal advice and it may be prudent to consult with an attorney regarding its completion and the implications therein.
Form Features
| Fact Name | Description |
|---|---|
| Definition | The Kansas Medical Power of Attorney form allows an individual to designate someone to make medical decisions on their behalf if they become incapacitated. |
| Governing Law | This form is governed by the Kansas Statutes Annotated, specifically K.S.A. 75-3201 et seq. |
| Principal's Authority | The principal retains the right to revoke or change the designated agent at any time while they are still competent. |
| Agent's Responsibilities | The appointed agent must act in the best interest of the principal, making decisions that align with their wishes and values. |
| Witness Requirements | The form must be signed in the presence of two witnesses or a notary public to be considered valid. |
| Durability | This power of attorney remains effective even if the principal becomes mentally incapacitated, ensuring continuous medical decision-making. |
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