Get Medical Excuse Form - Yavapai County Courts Website

Completing the Medical Excuse Form for Yavapai County Courts is essential for individuals seeking relief from jury duty due to health reasons. This guide will provide clear instructions to help users navigate the online filling process effectively.

Follow the steps to complete the form online.

1. Press the ‘Get Form’ button to access the Medical Excuse Form and open it in your preferred online editor.
2. Fill in the patient’s name and date of birth at the top of the form.
3. Provide the patient’s address, including city, state, and zip code.
4. Enter the juror badge number if available.
5. Detail any mobility, physical, or mental restrictions preventing the individual from serving.
6. List the specific symptoms that render the person unfit for jury duty, along with the duration of these symptoms.
7. Indicate when the individual will be able to serve as a juror again.
8. Select the appropriate employment status by checking the corresponding box: employed, unemployed, or retired.
9. Have the physician, physician assistant, RNP, or professional caregiver print their name and provide their business address and phone number.
10. Enter the physician's license number along with the state and zip code.
11. If applicable, provide the specialty, physician assistant license number, and nurse practitioner certificate number.
12. Affirm the validity of the content by signing and dating the form.
13. Once completed, save your changes, download the form, and share or print it as necessary.

Start filling out your Medical Excuse Form online today to ensure your request is processed smoothly.