Advance Directives

Welcome to Salina Regional Health Center—Confidence for the Good Life

Advance Directives are papers that state a patient's choices for treatment. This includes decisions like refusing treatment, refusing to be placed on life-support, and stopping treatment at a point the patient chooses. It also includes requesting life-sustaining treatment if that is wanted.

It is important to talk with your family, friends and doctor about what your wishes are if you become seriously ill. This is not easy, so many people ask for a tool to guide them through this conversation. Five Wishes is a living will/advance directive that helps you talk about your personal, emotional and spiritual needs. You can learn more about this tool by going to Five Wishes web site at There is a small cost associated with the Five Wishes booklet, however the SRHC Foundation has purchased some Five Wishes booklets for our patients to use. If you would like to obtain a free copy of the Five Wishes booklet (while supplies last) submit your request to contact us here.

Advance Directive Forms

There are several kinds of Advance Directives. These include, but are not limited to a Living Will, Patient Self-Determination, and a Durable Power of Attorney for Health Care. In this section you will find helpful information about each form as well as the ability to download each form.

Making sure the forms are available to your family, friends and physicians is easier now with the option of saving them online. The document can be uploaded to You can also upload a video file of you talking about your wishes.

Advance Directive Information

The Durable Power of Attorney for Health Care/Psychiatric Advance Directive

Durable Power of Attorney for Health Care/Psychiatric Advance Directive (PAD) allows a currently competent person who lives with a mental illness to make their wishes known with a legal document. This allows a person to be prepared if a mental health crisis prevents them from being able to make decisions. A PAD describes treatment preferences, or names a person to make treatment decisions, should the person with a mental health condition be unable to make decisions.

The agent is given the power to make health care decisions. Specific instructions can be given to the agent. The agent and the health care providers must follow the patient's wishes. They must also respect any wishes that are stated in a Living Will, a Patient Self Determination form, and a Pre-Hospital Do Not Resuscitate form or other Advance Directives.

To be effective, the document must be notarized or witnessed by two adults who are not related to and who will not inherit from the person signing the document. They also cannot be a health care provider involved in the patient's care.

The Living Will or Patient Self Determination

The law allows any competent adult to sign a Living Will or Patient Self Determination form for themselves only. This form states that life-sustaining procedures should be withheld or withdrawn. This only goes into effect when the patient can no longer make decisions. Medical procedures which are necessary to provide comfort or pain relief are not considered "life-threatening procedures."

For the Living Will or Patient Self Determination form to be effective, two physicians must personally examine the patient and determine that the patient has a terminal illness. The physicians agree that death will occur whether or not the medical procedure or intervention is done. The form is not effective if the patient is pregnant. In Kansas, the Living Will or Patient Self Determination form must be notarized or signed by two witnesses. Advance Directives completed at Salina Regional Health Center (SRHC) are notarized, not witnessed.

These witnesses must be two adults who are not related to the person making the Living Will or Patient Self Determination form, and who will not inherit from the person. They also must not be financially responsible for the patient, or a health care provider directly involved in the patient's care.

Advance Directives Policy

SRHC honors valid or legally completed Advance Directives. No patient will be discriminated against, regardless of whether or not they have completed an Advance Directive.

If your physician or the hospital cannot carry out your wishes, your care will be transferred to another physician or hospital that is willing to follow your instructions.

The Patient Self Determination Act

The Patient Self Determination Act is a federal law that requires hospitals to "provide written information" to adult in-patients concerning "an individual's right under state law ... to make decisions concerning ... medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate Advance Directives." To help patients make these choices, Kansas law provides for Advance Directives.

Here’s How It Works

You have the right to information about your medical condition, diagnosis, prognosis and possible treatments.

You may choose a Durable Power of Attorney for Health Care, a Living Will, and/or a Patient Self determination form.

If you choose to make an Advance Directive, the hospital will provide the necessary forms if you request. You do not need a lawyer in order to make an Advance Directive.

If you make Advance Directives, you should discuss them with your physician and your agent that you choose. You are responsible for making copies available to him or her and all other doctors you deal with. You should also discuss and share copies of your Advance Directive with your family members. It is always a good idea to keep copies yourself. Remember you must bring a copy of your Advance Directive with you each time you are admitted to the hospital.

If you wish to change your mind about your Advance Directives at a later date, you may do so. A Living Will, Patient Self Determination form, or other Advance Directives presented on admission or during the course of the patient's hospitalization may be revoked by: a) A competent patient destroying the document, or b) A competent patient signing a written revocation or, if the patient is mentally competent but physically unable to destroy the document or sign a written revocation, by instructing two persons that he wishes the document revoked and having those persons execute a written verification of the instructions specifying the date and time or revocation, or c) In the case of an incompetent patient, a court order revoking the document.

A Durable Power of Attorney for Health Care can be formally revoked by the patient, if the patient is then competent to do so, and provided such revocation is in writing and witnessed in writing before two disinterested witnesses or notarized.