Kansas Living Will Declaration Form

Kansas Living Will Declaration Form

Definition 

• § 65-28,102(b) 

"Statement" signifies a document witnessed and recorded as a hard copy, willfully carried out by the principal as per the prerequisites of K.S.A. 65-28,103. 

Laws

• Signing Requirements – Two witnesses (§ 65-28,103).

• Statute – § 65-28,103

Step by step instructions to write a Kansas living will

Stage 1 – Declaration of Declarant/Principal – The following should be carefully entered. 

• The date the declaration was made should be entered in this pattern: dd/mm/yyyy

• Then the complete legitimate name of the Principal/Declarant should then be entered

• Birthdate

• The resident city of the declarant

• The resident county of the declarant 

• The resident state of the declarant  

• In the event that the principal is keen on giving extra directions, they may do so by giving them on the space provided at the overside of this form, or they might attach a piece of paper with extra guidelines and append to the declaration form.

• Check the correct box showing if you want to give additional instructions or not

• The Declarant/Principal should then sign the document

Stage 2 – This report should be recognized by a public legal (notary) official or witnesses (two in number) 

• The witnesses; if they are to sign the form, shouldn’t be identified with the declarant by marriage, adoption, or blood. In other words, they should NOT have a family relationship with the principal. They should not be beneficiary to any part of the possessions of the declarant, and not the slightest bit be financially liable for any part of the medical care of the principal. If the witnesses will sign the form, they should go through the data in the document thoroughly, and afterward, the following should be duly entered.

First witness

• Signature of witness 

• The complete residential address of the witness 

Second witness

• Signature of witness 

• The complete residential address of the witness 

OR 

Notary Public – If it has been decided for the public legal (notary) official to witness the document, right after seeing the declarant's signature, the official will then finish the notary segment of the form and join their legal official seal for confirmation.

Stage 3 – Optional Additional Instructions – If the Principal/Declarant might want to give extra clinical data with respect to their desires, they might start with perusing the data found in the second page. If the Principal/Declarant might want to continue with different choices, tick True or False to answer the statements accordingly.

If any of these conditions portrayed in the previous passage exist, I demand that the measures below should be administered in general or intercessions EXCEPT for ones that were denoted "No" by me

Stage 4 – The declaration should be carefully reviewed and the extra data should be duly entered in the Kansas living will

• I think about a significant personal satisfaction to incorporate the accompanying, which will be thought about by any guardians as well as proxy leaders in deciding my course of clinical treatment

Stage 5 – The following should be reviewed carefully and additional instructions should be added 

• Other instructions are executed as the following:

Stage 6 – Signatures – This section of the form should likewise be recognized by a legal (notary) official or witnesses (two in number)

• The witnesses; if they are to sign the form, shouldn’t be identified with the declarant by marriage, adoption, or blood, in other words, they should have a family relationship with the principal. They should not be beneficiary to any part of the possessions of the declarant, and not the slightest bit be financially liable for any part of the medical care of the principal. On the off chance that the witnesses will sign the form, they should go through the data in the document thoroughly, and afterward, the following should be duly entered.

First witness

• Signature of witness 

• The complete residential address of the witness 

Second witness

• Signature of witness 

• The complete residential address of the witness 

OR 

Notary public 

• Signature 

• Full name 

• Notary seal