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Kentucky Living Will Form (Advance Directive)

The Kentucky Advance Health Care Directive form, or Living Will is drawn up in reference to the US Statutes §§311.621 to 311.644. The document is provided to facilitate a person legally the power to tell medical staff how they wish to be treated in the future should they become so seriously ill that they are incapacitated. Examples of this could be mental impairment or paralysis. The control over specific procedures is also excepted in the impending event of their death. A Kentucky living will form requires two witness or a notary.

How to Write

Kentucky Living Will Directive And Health Care Surrogate Designation

The principal must carefully read the document and then complete the relevant blank fields.

 

The Principal

The principal must enter their personal details.

  • Name.
  • Date of birth.

 

The Agent

The agent`s details and alternative agent`s must be entered.

  • Check box and initial to nominate a surrogate (Agent).
  • Name of agent.
  • Name of alternative agent.

 

Living Will Directive

 

Life Prolonging Treatment

The principal must decide on the course of action regarding prolonging of life.

  • Check box and initial to withdraw or withhold treatment except for alleviation of pain.
  • Check box and initial to receive life prolonging treatment.
  • Check box and initial to withdraw or withhold artificial hydration and nutrition.
  • Check box and initial to receive artificial hydration and nutrition.
  • Check box and initial to authorize the surrogate to decide whether artificial hydration and nutrition should be withdrawn or withheld.

 

Donation

The principal should decide if they would like to make donations after their death.

  • Check box and initial to donate any needed tissues, organs, eyes and corneas.
  • Check box and initial to donate any needed organs.
  • Check box and initial to donate all needed tissues.
  • Check box and initial to donate Corneas.Eyes.
  • Check box and initial to donate any other items.
  • Check box and initial to donate only specif organs and tissues entered here.

 

Declaration

Those persons involved with this document must give their personal details regarding understanding of the Living Will.

  • Date.
  • Signature of witnesses.
  • County.
  • Date.
  • Signature of notary.
  • Date commission of notary expires.