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KRS CHAPTER 202A ? HOSPITALIZATION of the MENTALLY ILL  Form

KRS CHAPTER 202A ? HOSPITALIZATION of the MENTALLY ILL Form

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Out. I designate _____________________________ to act as my surrogate. If this person withdraws or is unwilling to act on my behalf, or if I revoke that person's authority to act as my surrogate, I designate _____________________________ to act as my alternate surrogate. If I do not designate a surrogate, if my surrogate and alternate surrogate withdraw or are unwilling to act on my behalf, or if I revoke their authority to act, then the health care provider and health care facility may proceed...
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