$23.95

Add to cart

Kentucky _______________________ Execution of this document restricts withholding and withdrawing of some medical procedures. Consult Kentucky Revised Statutes or your attorney. -2- signed and dated as above. Done this ________________ day of __________, 20____ ________________________________________________ Signature of Notary Public or other officer. Date commission expires:_e me, the undersigned authority, came the grantor who is of sound mind and eighteen (18) years of age, or older, and acknowledged that he voluntarily dated and signed this writing or directed it to be_________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ OR STATE OF KENTUCKY) ______________.County) Beford signed for the grantor. _____________________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ _________________________________________ In our joint presence, the grantor, who is of sound mind and eighteen (18) years of age, or older, voluntarily dated and signed this writing or directed it to be dated anto make this directive. Signed this ____________ day of ____________ 20_____ Signed: ____________________________________________________________________ Address: _____________________________________n to my attending physician, this directive shall have no force or effect during the course of my pregnancy. I understand the full import of this directive and I am emotionally and mentally competent ve as the final expression of my legal right to refuse medical or surgical treatment and I accept the consequences of the refusal. -1- If I have been diagnosed as pregnant and that diagnosis is knowt and artificially provided nutrition and hydration, it is my intention that this directive shall be honored by my attending physician, my family, and any surrogate designated pursuant to this directi specified in KRS 311.185. _________ DO NOT authorize the giving of all or any part of my body upon death. In the absence of my ability to give directions regarding the use of life-prolonging treatmenes that withholding or withdrawing is in my best interest; but I do not mandate that withholding or withdrawing. _________ Authorize the giving of all or any part of my body upon death for any purposely provided nourishment or fluids. _________ Authorize my surrogate, designated above, to withhold or withdraw artificially provided nourishment or fluids, or other treatment if the surrogate determinificially provided food, water, or other artificially provided nourishment or fluids. _________ DO NOT authorize the withholding or withdrawal of artificially provided food, water, or other artificialf any medical treatment deemed necessary to alleviate pain. _________ DO NOT authorize that life-prolonging treatment be withheld or withdrawn. _________ Authorize the withholding or withdrawal of artly with my wishes as indicated below: _________ Direct that treatment be withheld or withdrawn, and that I be permitted to die naturally with only the administration of medication or the performance o surrogate(s). Any prior designation is revoked. If I do not designate a surrogate, the following are my directions to my attending physician. If I have designated a surrogate, my surrogate shall compI no longer have decisional capacity. If __________________________________________________ refuses or is not able to act for me, I designate ________________________________________ as my health careiate lines, I specifically: Designate ______________________________________________________ as my health care surrogate(s) to make health care decisions for me in accordance with this directive when ave decisional capacity, have a terminal condition, or become permanently unconscious have been indicated by checking and initialing the appropriate lines below. By checking and initialing the approprrms of Use found at findlegalforms.com -2- Living Will Directive My wishes regarding life-prolonging treatment and artificially provided nutrition and hydration to be provided to me if I no longer hwith another party. Any possible tax consequences arising out of this document should be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Teirst. Before using or signing this document you should have an attorney review it to make sure it fits your particular situation. You should also consult an attorney whenever a document is negotiated itute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used without consulting with an attorney fd or express warranties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substr act as surrogate unless related to the grantor -1- within the fourth degree of consanguinity or affinity or a member of the same religious order. [_] These forms are provided "as is" and no implieen waiting for the surrogate to make a health care decision. (4) An employee, owner, director, or officer of a health care facility where the grantor is a resident or patient shall not be designated o advance directive may resign at any time by giving written notice to the grantor; to the immediate successor surrogate, if any; to the attending physician; and to any health care facility which is ths as a notary public; (d) An attending physician of the grantor; or (e) Any person directly financially responsible for the grantor's health care. (3) A person designated as a surrogate pursuant to anor; (b) A beneficiary of the grantor under descent and distribution statutes of the Commonwealth; (c) An employee of a health care facility in which the grantor is a patient, unless the employee servefollowing shall be a witness to or serve as a notary public or other person authorized to administer oaths in regard to any advance directive made under this section: (a) A blood relative of the grantitnessed by two (2) or more adults in the presence of the grantor and in the presence of each other, or acknowledged before a notary public or other person authorized to administer oaths. None of the jurisdiction to be invalid, that invalidity shall not affect the directive. (2) An advance directive shall be in writing, dated, and signed by the grantor, or at the grantor's direction, and either wher specific directions which are in accordance with accepted medical practice and not specifically prohibited by any other statute. If any other specific directions are held by a court of appropriate Power of Attorney for Health Care Form. 311.625 Form of living will directive (1) A living will directive made pursuant to KRS 311.623 shall be substantially in the following form, and may include otr of Attorney for Health Care and a Living Will and is based on Kentucky Statutes Chapter 311 Section 623 et. Seq. The following are useful excerpts from the Kentucky Statutes relating to the KentuckyPower of Attorney for Health Care and Living Will); (2) Kentucky Living Will Directive (Power of Attorney for Health Care and Living Will) Form. This Kentucky Living Will Directive contains and a PoweInformation and Instructions Kentucky Living Will Directive (Power of Attorney for Health Care & Living Will) This package contains (1) Information and Instruction for Kentucky Living Will Directive ( Kentucky