A Kentucky Living Will form is a legal document that allows individuals to outline their preferences for medical treatment in case they become unable to communicate their wishes. This form ensures that your healthcare decisions are respected, even when you cannot express them yourself. Understanding how to create and use this form can provide peace of mind for you and your loved ones.
In the state of Kentucky, the Living Will form serves as a crucial document for individuals who wish to outline their preferences regarding medical treatment in the event they become unable to communicate their wishes. This form allows you to express your desires about life-sustaining measures, ensuring that your values and choices are respected even when you cannot voice them. Key aspects of the Kentucky Living Will include the specification of your wishes regarding resuscitation, artificial nutrition, and hydration, as well as the appointment of a healthcare surrogate if desired. By completing this form, you not only provide guidance to your loved ones and medical providers but also relieve them of the burden of making difficult decisions during emotionally challenging times. Understanding how to properly fill out and execute this document is essential for anyone looking to assert control over their healthcare decisions, making it an important part of responsible planning for the future.
Kentucky Living Will Document
This Living Will document is crafted in accordance with the Kentucky Living Will Directive Act. It serves as a declaration of one's desires regarding the provision, withholding, or withdrawal of life-sustaining treatment in the event that they can no longer express informed consent.
Part 1: Declaration Information
Full Name: ________________________________________
Date of Birth: ________________________________________
Address: ________________________________________
City, State, ZIP: Kentucky, __________, ________
Primary Phone: ________________________________________
Alternate Phone: ________________________________________
Part 2: Health Care Directive
I, ______________________ (insert full name), being of sound mind, willfully, and voluntarily make this declaration to be followed if I become unable to participate in decisions regarding my medical care. This directive indicates my wishes regarding life-sustaining treatment, artificial nutrition, and hydration:
If I am in a terminal condition or in a state of permanent unconsciousness, and if my attending physician and one other physician determine that there is no reasonable expectation of recovery, I direct that:
I direct that if I am in the condition described above, the following measures be taken regarding artificial nutrition and hydration:
My specific desires regarding artificial nutrition and hydration are as follows: _______________________________.
Part 3: Signature
This Living Will shall remain in force until revoked by me. I understand the full import of this declaration and I am emotionally and mentally competent to make this declaration.
Date: _______________________________
Signature: _______________________________
Part 4: Witness
The Declaration needs to be signed in the presence of two witnesses. The witnesses must not be related to the declarant by blood or marriage, entitled to any portion of the estate of the declarant, or directly financially responsible for the declarant's medical care.
Witness 1: Name: ________________________________________ Signature: ________________________________________ Date: ________________________________________
Witness 2: Name: ________________________________________ Signature: ________________________________________ Date: ________________________________________
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