Get our app
Account Sign up Sign in

MAKE YOUR FREE Kentucky Medical Power of Attorney

Make document
Other Names: Kentucky Healthcare POA Kentucky Healthcare Power of Attorney Kentucky Medical POA Kentucky Healthcare Proxy
Kentucky Medical Power of Attorney document preview

What is a Kentucky Medical Power of Attorney?

A Kentucky Medical Power of Attorney is a legal document that gives a trusted person the authority to make healthcare decisions for you, such as refusing or requesting a specific medical treatment, when you cannot do so. 
The person granting control is known as the "principal," while the people or organizations receiving authority are called the "agents." Suited for residents of Kentucky, this Power of Attorney for health care is made for use in Jefferson County, Fayette County, Kenton County, and in all other counties across the state. All Kentucky Healthcare PoA forms from Rocket Lawyer can be personalized to address your specific situation. As a result of this essential document, your agent(s) will be able to offer proof to healthcare institutions and other parties that they can legally act in your interest.

When to use a Kentucky Medical Power of Attorney:

  • Someone you trust with your health has agreed to act on your behalf, and you want to make it official.
  • You have declining health and want to get prepared.

Sample Kentucky Medical Power of Attorney

The terms in your document will update based on the information you provide

This document has been customized over 8.6K times
Legally binding and enforceable
Ask a lawyer questions about your document




By checking and initialing the appropriate lines, I specifically provide the following authorization:


If refuses or is not able to act for me, I designate:


Surrogate Name:






as my health care surrogate.


If the person I designate as surrogate or an alternate surrogate is or ever becomes my spouse, he or she shall be ineligible to serve as my surrogate if our marriage is annulled, or we are divorced.


. SEVERABILITY. If any provision in this document is held to be invalid, such invalidity shall not affect the other provisions which can be given effect without the invalid provision, and to this end the directions in this document are severable.


In the absence of my ability to give directions regarding the use of life-prolonging treatment 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 directive as the final expression of my legal right to refuse medical or surgical treatment and I accept the consequences of such refusal. I understand the full import of this directive and I am emotionally and mentally competent to make this directive.


Signed this _____ day of __________________, _____.




Grantor Signature: ______________________________________








Name: ________________________________

Address: ________________________________






Name: ________________________________

Address: ________________________________



two witnesses who then sign the document in your presence and in each other's presence.a notary who then notarizes the document.

_____ (your Health Care Surrogate)


* You should discuss the document and your wishes with any person you want to designate as a Health Care Surrogate before doing so to assure they agree to act on your behalf.

Kentucky Medical Power of Attorney FAQs

Collapse all
Expand all
  • How do I get a Kentucky Medical Power of Attorney form for free?

    It's fast and easy to grant or obtain the authority you may need with a free Kentucky Medical Power of Attorney template from Rocket Lawyer:

    1. Make your PoA - Provide a few details and we will do the rest
    2. Send and share - Go over it with your agent(s) or get legal help
    3. Sign it - Required or not, witnesses/notarization are a best practice

    This solution is, in many cases, notably more affordable and convenient than finding and hiring a traditional provider. If needed, you may fill out this Medical PoA on behalf of your spouse or another family member, and then have that person sign when ready. Please note that for a Power of Attorney to be accepted as legally valid, the principal must be an adult who is mentally competent at the time of signing. In the event that the principal is already unable to make their own decisions, a court-appointed conservatorship may be required. In such a situation, it's best for you to talk to a lawyer .

  • Who should have a Power of Attorney for healthcare in Kentucky?

    Every person over 18 years old should have a Medical Power of Attorney. While it may be tough to acknowledge, there might come a day when you aren't able to make your own medical decisions. Typical occasions where power of attorney may be useful include:

    • You have plans to move into a residential care facility
    • You have been given a terminal diagnosis
    • You are getting older or dealing with ongoing health issues
    • You are planning for an upcoming medical procedure or period of hospitalization

    Whether your Kentucky Medical Power of Attorney has been drafted as part of a forward-looking plan or produced as a result of an urgent issue, witnesses and notarization are strongly encouraged as a best practice for protecting your agent if their power and authority are challenged.

  • What are the differences between a Kentucky Healthcare Proxy and a Kentucky Medical Power of Attorney?

    Sometimes, in the process of researching the topics of estate planning or elder care, you or a loved one might hear the terms "healthcare power of attorney", "medical power of attorney" and "healthcare proxy" used interchangeably. In actuality, they're the same. That said, please keep in mind that it's absolutely possible to get agency over affairs that are not health-related. In that case, "proxy" is not typically used.

  • Do I need a lawyer for my Kentucky Medical PoA?

    Kentucky Medical PoA forms are usually simple, but you or your agent(s) might still have legal questions. Hiring an attorney to look over your document can take longer than you would expect if you do it on your own. An alternate approach to consider is to request help from Rocket Lawyer attorney services. Premium members have the ability to ask for guidance from an attorney with relevant experience or pose additional questions. As always, you can Live Confidently® with Rocket Lawyer by your side.

  • What might it normally cost to get a Power of Attorney form for health care in Kentucky?

    The fees associated with finding and working with a legal provider to generate a Medical Power of Attorney could add up to between $200 and $500, based on your location. Unlike most other Power of Attorney template providers that you might encounter, Rocket Lawyer gives Premium membership holders up to a 40% discount when hiring a lawyer, so an attorney can assess the situation and take action if you ever need assistance.

  • Are there any additional actions that I should take after I have drafted a Kentucky Medical Power of Attorney?

    With a Premium membership, you will be able to edit it, save it in PDF format or as a Word file, and/or print it. To make your Power of Attorney legally binding, you must sign it. You should provide a copy of your fully signed document to your agent(s), care providers, and other impacted parties.

  • Does a Medical Power of Attorney need to be notarized, witnessed, or recorded in Kentucky?

    The specific requirements governing PoA forms are different in each state; however, in Kentucky, your document will need notarization or the signatures of two witnesses. Witnesses to a Healthcare PoA must not be your attending physician or anyone responsible for your healthcare costs, nor can they be affiliated with your healthcare facility unless providing notary services. Relatives or other beneficiaries are also restricted. As a basic principle, your witness(es) should be at least 18 years old, and no witness should simultaneously be acting as your agent.

    See Kentucky Medical/Healthcare Power of Attorney law: § 311.629

Kentucky Medical Power of Attorney document preview

Create Your Document In Just 3 Easy Steps:

Build your document

Build your document

Answer a few simple questions to make your document in minutes

Right-facing arrow
Save now, finish later

Save now, finish later

Start now and save your progress, finish on any device

Right-facing arrow
Download, print & share

Download, print & share

Store securely, share online and make copies

Right-facing arrow

Ask a lawyer

Our network attorneys are here for you.
0/600 !

You've exceeded the character limit.

Rocket Lawyer Network Attorneys

Looking for something else?

Start your Kentucky Medical Power of Attorney now and get Rocket Lawyer FREE for 7 days

Get legal services you can trust at prices you can afford. You'll get:

All the legal documents you need—customize, share, print & more

Unlimited electronic signatures with RocketSign®

Ask a lawyer questions or have them review your document

Dispute protection on all your contracts with Document Defense®

30-minute phone call with a lawyer about any new issue

Discounts on business and attorney services