Kentucky Medical Power of Attorney Form [PDF]

Read our comprehensive guide on how to appoint someone to be your healthcare agent by issuing a Kentucky medical power of attorney.

Last update: 27 Mar 2024

Kentucky Medical Power of Attorney Form [PDF]

The Kentucky medical power of attorney, or healthcare power of attorney, is a legal document that delegates the authority to make healthcare decisions from one person, called the principal, to another person, called the agent or the attorney-in-fact.

The principal can issue a Kentucky medical power of attorney if they are in unstable health and want to authorize someone to make decisions about their healthcare in general. 

This document can also be used if the principal is diagnosed with a terminal illness or is facing complicated surgery and wants to outline their end-to-life preferences.

Laws and Legal Requirements for a Medical Power of Attorney in Kentucky

Laws and Legal Requirements

Title 26, Sections 311.621 to 311.647 of the Kentucky Revised Statutes regulate the status of durable power of attorney in Kentucky.

As provided by §311.625, the Kentucky medical power of attorney must be signed by at least two witnesses or a notary public. If you cannot sign the document, you can have another person sign it in your presence.

The power of attorney is valid indefinitely or until the principal revokes it. After the revocation, the principal should notify their agent and healthcare provider about their revocation, as provided by §311.627.

How to Write a Medical Power of Attorney in Kentucky

To draft a valid medical power of attorney in Kentucky, you should follow the step-by-step process outlined below:

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

Here, you can find the medical power of attorney template, which will include all the relevant information that should be provided for the medical power of attorney to be valid and effective.

Right after opening the medical power of attorney form, our professional legal document builder will provide you with detailed instructions on how to fill out the form. 

First, you should enter the principal’s full name, mailing address, contact details, and the date of issuing the power of attorney.

#2. Appoint a Healthcare Representative

In this section, you should appoint the agent, also called the attorney-in-fact, to be your healthcare representative. You can do so by entering the full name, mailing address, and contact details of the person you wish to name as your agent.

This should be a person of legal age with the legal capacity to represent you. Moreover, it should be a trustworthy person, considering the importance of the authority you are delegating to them. It can be your spouse, your relative, your friend, or a trusted advisor.

Here, you can also define your agent’s scope of authority by providing the medical power of attorney rights and limitations.

#3. Identify an Alternative Healthcare Representative

Here, you should appoint a successor agent who will act only in case your primary agent is unable or unwilling to represent you and make healthcare decisions on your behalf.

The medical POA form should include the successor agent’s full name, mailing address, and contact details. The successor agent should fulfill the same basic requirements as the primary agent. Also, they will have the same scope of authority as the primary agent. 

#4. Identify the Witnesses and Have Them Sign the Form

After completing your power of attorney form, you should print and sign it. When signing it, you should have at least two witnesses sign the document and confirm that you have personally signed it. 

The witnesses should be of legal age and have the legal capacity to sign the form. If you fail to provide the witness signatures, your document will be considered invalid.

#5. Notarize the Form

Finally, you should have the notary public acknowledge the medical power of attorney. This will additionally confirm the authenticity of the document and prevent potential fraud.

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