Kansas Living Will Template
This Living Will is created in accordance with the laws of the State of Kansas. It serves to outline your preferences regarding medical treatment in the event that you become unable to communicate your wishes.
Please fill in the information below:
- Full Name: ___________________________
- Date of Birth: ______________________
- Address: ____________________________
- City, State, Zip: ___________________
- Phone Number: _____________________
In the event that I am unable to make my own medical decisions, I wish to provide the following instructions regarding my healthcare:
- Life-Sustaining Treatment: I do not want life-sustaining treatment if:
- My condition is terminal, and I am unable to make decisions.
- I am in a persistent vegetative state.
- Specific Treatments: I wish to receive the following treatments:
- ______________________________
- ______________________________
- Organ Donation: Upon my death, I wish to:
- Donate my organs and tissues.
- Not donate my organs and tissues.
This Living Will shall be effective when my physician determines that I am unable to make my own medical decisions.
Signed: ___________________________
Date: _____________________________
Witness 1: _________________________
Witness 2: _________________________
It is advisable to keep this document in a safe place and share copies with your healthcare providers and family members.