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Providing free legal services to the lowincome and vulnerable in eastern and south central Kentucky. A medical power of attorney form allows a person (principal) to select an agent to make healthcare decisions on their behalf.A Kentucky minor power of attorney form permits a parent to designate an agent to make healthcare and educational decisions on behalf of their child. The form in this guide is a simple version of a Health Care Advance Directive. This power of attorney does not authorize the agent to make health care decisions for you (please see Health Care Power of Attorney (DC ). The agent can have broad legal authority or limited authority to make decisions about the principal's property, finances, or medical care. I,. (insert your name) appoint: Name: Address: Phone: as my agent to make any and all health care decisions for me, except to the extent I state otherwise. Several legal and medical terms are used in this document. For convenience they are explained below. Several legal and medical terms are used in this document.