Kentucky Advance Directive Form (Medical POA & Living Will)

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The Kentucky Advance Directive combines the attributes of a “living will” and “medical power of attorney” to form one all-encompassing document. Traditionally, a living will allows its executor to clarify their wants pertaining to end-of-life care, whereas a medical POA facilitates the appointment of an agent to manage healthcare decisions on the behalf of the principal. With that being said, the terms advance directive and living will are used synonymously in the state of Kentucky as their version of the living will comes equipped with a “health care surrogate designation” that essentially provides the same effect as a medical POA. To fulfill the requirements of this instrument, the principal must:

  • indicate whether or not they choose to designate a health care surrogate;
  • establish their desires regarding life-ending decisions;
  • and supply their endorsement in the form of a signature which is to be witnessed by two (2) eligible adults or a notary public.

(Residents of Kentucky who are interested in becoming an organ donor can visit the Donate Life KY Website for more information on the enrollment process.)

Other Versions (9)

AARP Version

Download: Adobe PDF
Instructions: Adobe PDF

 

 


Baptist Health Version

Download: Adobe PDF

 

 

 


Catholic Conference of Kentucky Version

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Five Wishes (Aging with Dignity) Version

Download: Adobe PDF
Information: Adobe PDF

 

 

 


Hosparus Health Version

Download: Adobe PDF

 

 

 


Methodist Hospital Version

Download: Adobe PDF

 

 

 


Norton Healthcare Version

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Prepare for Your Care Version (also available in Spanish/en Español)

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Spanish/Español Version

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Additional Resources

Related Forms (7)

Advance Directive for Mental Health Treatment

Download: Adobe PDF
Laws: § 202A.420 – § 202A.432

 

 


Advance Directive Wallet Cards

Download: Adobe PDF

 

 

 


Do Not Resuscitate (DNR) Order Form

Download: Adobe PDF
Instructions: Adobe PDF

 

 


Durable (Financial) Power of Attorney

Download: Adobe PDF, MS Word (.docx)

 

 

 


Living Will Supplement Form

Download: Adobe PDF

 

 

 


Medical Orders for Scope of Treatment (MOST) Form

Download: Adobe PDF
Laws: § 311.6225

 

 


Organ Donor Registry Form

Download: Adobe PDF
Laws: § 311.1911 – § 311.1959