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Free Kentucky Medical Power of Attorney Form

A Kentucky medical power of attorney names a health care surrogate in the first section of the state's living will directive. Build yours with our guided form and follow Kentucky's signing rules.

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  • E-sign included

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What Is a Medical Power of Attorney in Kentucky?

Kentucky handles this through a living will directive that includes a health care surrogate designation. According to the Kentucky Attorney General, the form’s first section lets you designate one or more surrogates, such as a family member.

Kentucky Rules for a Living Will Directive

Kentucky’s Living Will Directive Act, KRS 311.621 to 311.643, sets the rules.

Anyone 18 or Older Can Sign

The Attorney General notes that everyone 18 or older can have a living will directive. It is suspended during pregnancy.

State Law Sets the Form

KRS 311.625 specifies the form you should fill out. The Attorney General suggests seeing an attorney if you make changes to it.

Witnesses or a Notary

You can use two witnesses or a notary public in place of witnesses. The Attorney General also notes you do not need an attorney to draw up the document.

Who Cannot Witness or Notarize

The law bars these people:

  • Relatives and heirs
  • Your attending physician
  • Anyone directly financially responsible for your health care
  • An employee of the facility where you are a patient, unless serving as the notary

Can Facility Staff Be Your Kentucky Surrogate?

Usually not. An employee, owner, director, or officer of a facility where you live or receive care cannot be your surrogate. The exceptions are relatives within the fourth degree and members of the same religious or fraternal order.

The fourth-degree limit reaches first cousins and in-laws. If you trust someone on staff, check that relationship before naming them in your Kentucky medical power of attorney.

Your Surrogate Can Step Down

A Kentucky surrogate may resign at any time with written notice to you and the next surrogate. The notice also goes to the attending physician and any facility waiting on a decision. Naming a successor surrogate keeps things moving if that happens.

How to Sign Your Kentucky Medical Power of Attorney

Get your Kentucky medical power of attorney form ready in these steps:

  1. Complete the health care surrogate section with your first choice and a successor.
  2. Mark your choices on life-prolonging treatment and tube feeding.
  3. Note any wishes about organ donation.
  4. Sign before two qualified witnesses, or before a notary instead.
  5. Confirm no witness is a relative, heir, or your attending physician.
  6. Share copies with your surrogates and your doctors.

What to Include in Your Kentucky Form

The Attorney General describes four areas the living will directive covers:

  • Designating a health care surrogate
  • Refusing or requesting life-prolonging treatment
  • Refusing or requesting artificial feeding or hydration
  • Expressing your wishes on organ donation

You can name more than one person, such as a family member, in the surrogate section. Listing a successor matters because a Kentucky surrogate is free to resign.

Because the statute specifies the form, keep your Kentucky medical power of attorney close to its wording and get legal advice before adding new terms.