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Free Kentucky Medical Power of Attorney Forms

Create a Kentucky-compliant healthcare power of attorney to appoint a trusted healthcare surrogate. Includes HIPAA authorization, end-of-life preferences, and all provisions required under KRS § 311.625.

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Kentucky Healthcare Power of Attorney
PDFWord
Kentucky-compliant
Page 1 of 5
SG

Written by

Stefan Gol
AH

Fact-checked by

Anderson Hill
JD

Legally reviewed by

John Doe

Last updated April 3, 2026

Kentucky Healthcare Power of Attorney Overview

In Kentucky, a healthcare power of attorney is governed by KRS § 311.625. This legal document allows you to designate a healthcare surrogate who can make medical decisions on your behalf if you become unable to make or communicate those decisions yourself. Kentucky law ensures that your healthcare surrogate has the authority to work with healthcare providers to carry out your wishes regarding medical treatment.

Your healthcare surrogate can make decisions about medical treatments, surgeries, medications, hospital stays, end-of-life care, and access to your medical records. The healthcare power of attorney typically takes effect only when a physician determines that you are unable to make decisions for yourself, though Kentucky law may allow you to make it effective immediately if you prefer.

Creating a healthcare power of attorney in Kentucky requires 2 witnesses and notarization is strongly recommended. While Kentucky does not mandate a specific form, the document must meet all requirements under KRS § 311.625.

No

Statutory form required

2

Witnesses required

Recommended

Notarization

Recommended

HIPAA included

Kentucky Requirements

To create a valid healthcare power of attorney in Kentucky, you must meet the following requirements under KRS § 311.625:

Important: Kentucky Execution Requirements

Kentucky requires 2 witnesses for a valid healthcare power of attorney. Notarization is strongly recommended for added legal protection. Witnesses cannot include your designated healthcare surrogate or your treating healthcare provider.

  • Legal Age: You must be at least 18 years old and mentally competent at the time of signing
  • Witnesses: Kentucky requires 2 witnesses who are not the healthcare surrogate or healthcare provider
  • Notarization: Recommended in Kentucky
  • Agent Designation: Name a primary healthcare surrogate and optionally an alternate
  • HIPAA Authorization: Recommended to include separately

How to Create Your Kentucky Healthcare Power of Attorney

Follow these steps to create a valid healthcare power of attorney that complies with Kentucky law.

1

Choose Your Healthcare Surrogate

Select a trusted individual to serve as your healthcare surrogate in Kentucky. This person should understand your healthcare values, be willing to advocate on your behalf, and be available in case of emergency. Consider naming an alternate healthcare surrogate as well.

2

Specify Your Healthcare Wishes

Document your preferences regarding medical treatments, end-of-life care, organ donation, DNR orders, and mental health treatment. Be as specific as possible about what treatments you do and do not want under various circumstances.

3

Include HIPAA Authorization

Add HIPAA authorization to ensure your healthcare surrogate can access your medical records and communicate with your healthcare providers in Kentucky. Without this, providers may legally refuse to share your medical information.

4

Sign with Witnesses

Execute the document with 2 witnesses as required by Kentucky law. Notarization is strongly recommended for added legal protection. Distribute copies to your healthcare surrogate, physicians, hospital, and family members.

Choosing Your Kentucky Healthcare Surrogate

In Kentucky, your healthcare surrogate will have significant authority over your medical care. Choose someone who understands your values and can make difficult decisions under pressure.

  • Trustworthy: Someone who will follow your wishes, not impose their own preferences
  • Accessible: Someone who can be reached quickly and can travel to Kentucky if needed
  • Assertive: Someone who can communicate effectively with medical professionals
  • Emotionally capable: Someone who can handle the stress of making life-or-death decisions

Sample Kentucky Healthcare Power of Attorney

Below is a preview of our Kentucky-specific healthcare power of attorney template.

STATE OF KENTUCKY

HEALTHCARE POWER OF ATTORNEY

KRS § 311.625

PRINCIPAL (You):

Name: [Your Name]
Address: [Kentucky Address]

HEALTHCARE SURROGATE:

Name: [Agent Name]
Relationship: [Relationship]
Phone: [Phone]

Kentucky Healthcare Power of Attorney FAQ

Answers to common questions about Kentucky healthcare power of attorney requirements and procedures.

Official Kentucky Resources

Use these official resources to verify Kentucky requirements and access government forms.

Create Your Kentucky Healthcare Power of Attorney

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