Kentucky Living Will Form

The Kentucky living will is a legal document that is also called an “Advance Directive.” This allows an individual to plan in advance, how to direct medical providers with regard to their care when they are no longer able to make their medical decisions on their own, or in the event of an end of life situation. This document, once completed, must be signed by two unrelated witnesses or the document must be notarized. Copies should be made and provided to the Principal’s interested parties (family, medical providers, etc)


Laws – Kentucky Revised Statutes Chapter 311, Sections .621 to .643 – Kentucky Living Will Directive Act

How to Write

Step 1 – Download and establish the author of the document by placing the Principal’s printed name in the first line of the form:

  • Also enter the Principal’s date of birth in mm/dd/yyyy format
  • Read paragraph below the header

Step 2 – Designation of Health Care Agent (surrogate) – If the Principal would like to have an agent to assist in decision making if needed, the Principal must check the box and initial the line:

  • Enter the name of the designated Agent
  • Again enter the name of the designated Agent
  • If the first agent is unable or unwilling to serve on behalf of the Principal enter the name of an alternate agent

Step 3 – Living Will Directive – In the event the Principal will have no Health Care Agent, then the attending physician may refer to this document to get a better understanding of the wishes of the Principal:

  • Check and initial only one of the selections in this section that would best serve the Principal
  • Check and initial the last  box in this section if the Principal would like to become an organ donor
  • Check and initial any or all of the boxes that the Principal would be interested in providing upon death

Step 3 – Pregnancy – In the event of pregnancy diagnosis and the Principal wishes to sustain life until after the birth of the child:

  • Enter a signature date in dd/m/yy format
  • Enter the Principal’s signature

Step 4 – Witness Signatures OR Notarization –

  • If witnesses will be used to acknowledge this document, the witnesses must sign in the presence of one another
  • Witnesses must read the witness statement and qualify themselves as legitimate witnesses
  • Provide Witnesses Signatures and addresses (respectively)
  • OR
  • If the Principal would prefer to use a notary public the notary will witness the Principal’s signature and shall acknowledge the document by completing the notary section of the document and shall affix their official seal (if any)

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