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Kentucky Durable Medical Power of Attorney Form |
The Kentucky Power Of Attorney For Health Care form is a legally binding form in the state of Kentucky that enables a principal to appoint an agent to be the power of attorney with regards to the patient`s health if they can no longer be responsible for the decisions due to serious illnesses. The document requires two witnesses or a notary. One witness may not be a relative or health care provider of the principal. (§ 311.625(2))
How to Write
Kentucky Medical Power Of Attorney Form
The principal must appoint an agent and an alternative agent(s).
- Name of principal.
- Name of agent.
- Names of alternative agents.
Withholding Or Withdrawing Treatment
The principal must list the type of treatment they wish to be withdrawn or withheld.
- Initial to withdraw and withhold treatment except for the alleviation of pain.
- Initial to receive medical treatment in any circumstance.
- Initial to withdraw or withhold artificial hydration and nutrition.
- Initial to receive artificial hydration and nutrition.
- Authorize the agent to withdraw or withhold artificial hydration and nutrition.
Donation
The principal must give details regarding making a donation after death.
- Initial to authorize the donation of all or any body parts for any purpose.
- Initial to not authorize the donation of any body parts.
Signatures
The personal details and signatures must be entered of those persons involved with this document.
- Date.
- Principle`s signature.
- Principal`s address.
- Witnesses signatures.
- Witnesses addresses.
- County.
- Date.
- Signature of notary.
- Date commission expires.
