Thank you for downloading our template.
If you find the document valuable, please leave us a review. It really helps us get the word out and makes what we're doing even more worthwhile.
The Kentucky advance directive is a document that directs a medical facility on the medications a patient wants to be administered or whether the patient has appointed a medical agent to speak on their behalf. An advance directive consolidates a living will and a clinical authority of an attorney and makes a document that represents the medical choices of an individual. This form should be endorsed in accordance with state laws, in the presence of two witnesses or a notary public, and this document should be placed where it is protected with easy access for when it’s needed.
The following is contained in the Advance Directive
Health Care Surrogate Designation
Living Will Directive
Statute – Kentucky Living Will Directive Act (§ 311.621 to § 311.647)
Signing Requirements (§ 311.625(2)) – Two (2) or more witnesses 18 years or older or notary public.
State Definition (§ 311.621(2)) – "Advance directive" signifies a living will directive executed as per KRS 311.621 to 311.643, a living will or assigning of health care representative made before July 15, 1994, and whatever other form that gives instructions comparative with health care to be given to the individual executing the form.
(1) Printed Name. This document should be set up as per your order by being recognized as the Principal or Declarant in Kentucky giving directions on treatment for Doctors in Kentucky that are going to attend to you in the future.
(2) Date Of Birth. Your date of birth should be duly supplied to further cement your identity as the Declarant in Kentucky.
(3) Kentucky Health Care Surrogate Status. This directive gives the choice to delegate a Medical care Representative in Kentucky who is acknowledged to speak with Physicians in Kentucky and decide a clinical treatment if you are in a state of unconsciousness (coma) or unable to communicate. This individual can possibly execute this role if they are given the position. The agent’s name alongside their contact information where they can be reached should be supplied.
(4) Appoint The Kentucky Health Care Surrogate. The complete name of the Medical care agent in Kentucky you have selected for this task ought to be supplied in the approved declaration statement.
(5) Name Of Secondary Kentucky Health Care Surrogate. An extra individual can be assigned in this form to be known as a backup agent who doesn't have the power to execute the Principal’s orders except if the main Medical Care Representative in Kentucky that was assigned above is inaccessible, precluded, unfit, or reluctant to execute medical choices in the interest of the possible Patient or Principal in Kentucky this form is meant for. This precautionary measure can save significant time as it empowers the Principal to make sure their medical mandates stay open to doctors in Kentucky regardless of whether their primary agent is available.
(6) Alternate Health Care Surrogate In Kentucky. An extra representative can be assigned to accept the Medical care Representative in Kentucky job if your primary backup agent refuses the obligation or is unavailable to execute medical choices on your behalf.
(7) Deny Life-Prolonging Treatment. If you want, you can grant Medical Providers in Kentucky explicit guidelines to avoid life-sustaining therapies or medications at a time of experiencing a constant and incurable medical ailment that might bring about your demise or put you in a state of unconsciousness permanently.
(8) Consent To Life-Prolonging Treatment. On the other hand, in the event that you desire to get treatment or therapy that will help in prolonging your life without regarding the odds of endurance or recuperation when experiencing a life-threatening disease or incurable ailment, the second checkbox in this segment should be appropriately ticked and your indication of authorization should be supplied.
(9) Refuse Artificial Nutrition And/or Fluids. Your guidance to decline the clinical or artificial delivery of nutrition and water can be given to the Healthcare Personnel in Kentucky through your choice of the recommended statement then, at that point, initialing your approval to the following statement.
(10) Approve Artificial Nutrition And/or Fluids. To endorse Kentucky Medical Professionals' endeavors to supply your nutrition and water utilizing a pipe or through other artificial techniques/methodologies, the declaration that comes second regarding this matter should be ticked and blank on the right side should be duly initiated.
(11) Level Of Kentucky HealthCare Surrogate's Authority. Typically, the declaration with respect to techniques administered to prolong life given or the transfer of artificial nutrition and water will rescind the choices of your Medical care representative, notwithstanding, you can illuminate Physicians in Kentucky that you desire such choices executed by your medical care agent to outweigh your own directive. Select this statement and show your indication to officially give this order
(12) Authorize All Anatomical Gifts. This document empowers you to be an Organ Donor in Kentucky. By finishing the next segment, you will approve anatomical gifts which include tissues, muscles, or other parts of the body that would be needed by a beneficiary. If the box that comes first is selected, it means you are giving permission that whichever part of the body that is needed by a recipient should be donated upon your demise.
(13) Select Specific Anatomical Gifts. Assuming you like to just make specific anatomical gifts to a recipient, you can utilize the rundown given to choose then supply initial endorsement to give every required tissue, organ, eyes, corneas, or potentially some different parts of the body you have selected.
(14) Specify Authorized Anatomical Gifts. Assuming none of the gift terms above precisely mirror your wish then, you might choose the last choice by ticking the proper checkbox, initializing the space provided for it, then, at that point, list each tissue, organ, or part of the body that you have endorsed as anatomical gifts.
(15) Grantor's Signature Date. The date this document was signed ought to be supplied to advise Doctors in Kentucky and different Reviewers regarding when you executed this order. This is particularly helpful if this document is intended to supplant a past issue or on the other hand, in case it has been renounced and supplanted later on.
(16) Signature Of Execution. Your name should be signed to this report to confirm your desire for Health care workers in Kentucky to adhere to the directions for medication. It also consists of how you want to administer your medical care representative’s choice as per your desires. This signing should be done in the presence of witnesses (two in number) or a public legal (notary) official that is duly licensed by the state.
(17) Signature And Address Of Witnesses. The signature given by the Principal in Kentucky ought to be checked in order to determine its authenticity. For this to be possible, two Witnesses ought to be present to observe the Declarant in Kentucky as the individual in question put his signature on the document. After signing, the First Witness should peruse the assertion carefully, examining the Principal’s signature then, at that point, sign their own name. Note the present schedule date will likewise be expected of the Witness and ought to be identical to the date of the signature of the Declarant.
Notary Public
(18) Notary Public. An authorized Legal (notary) official can likewise give confirmation that the signature you supplied was genuine and it was signed when you are in a state of consciousness and right frame of mind. The person in question will be present when you are signing the document and then will authenticate your signature supplied by endorsing the document.