Advance Care Planning

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Durable Power of Attorney for Health Care Decisions

  • It allows you to name an individual who can legally make health care decisions for you during a time of disability or incapacity. The designated agent is often referred to as your DPOA.
  • The powers granted usually include: decision about health care, choice of physicians, and long term care.
  • The terms of the form may include: refusing or withdrawing consent for the use of life sustaining procedures, disposition of remains, or consent for organ donation and autopsy.
  • The person signing the form must be a legal adult and competent when the document is signed.
  • The individual who is appointed as your DPOA should be able to uphold your wishes for healthcare decisions in spite of their own preferences. It is important for the individual completing this form to share personal wishes and desires about health decisions with the named agent.
  • The healthcare agent (DPOA) may not cancel a person’s Living Will.

Declaration - Living Will

  • This form allows you to state in advance that your dying process should not be artificially prolonged in case of a terminal illness.
  • The Living Will applies only when the person has been diagnosed and certified terminally ill by two physicians.
  • The Living Will gives your designated DPOA and Physician's directions for your end of life wishes.  

Health Care Directive

  • It allows you to state in advance specific treatment options you would or would not want to receive. 
  • This form can help your DPOA to understand your treatment preferences.
  • The form may be filed in your medical record. 

Do Not Resuscitate Order Request Form

  • It allows you to elect to not have Cardio-Pulmonary Resuscitation (CPR) used when you are in a terminal state in your disease process.  In the state of Kansas, it is required to have a physician's signature.
  • This decision may be made only by you or your designated DPOA. 
  • This form states ’if my heart stops beating or if I stop breathing, no medical procedures to restart breathing or heart functioning will be instituted. No resuscitation will be attempted”.  
  • This form does not stop treatment measures, it only stops resuscitation efforts.  

Kansas General Durable Power of Attorney

  • This document provides authority to another person to make financial decisions on your behalf. 

Medical Alert Information

  • This document is to assist First Responders in their ability to care for you in times of critical emergencies.  The Medical Alert Information Sheet will provide crucial information about your medical conditions, diseases and medications to best treat you when there is an issue.