Get A Permanent Medical Excusal Form. - Escambia County Clerk

Filling out the A Permanent Medical Excusal Form is an important step for individuals unable to serve on a jury due to medical reasons. This guide will provide clear instructions on how to accurately complete the form to ensure your request is processed effectively.

Follow the steps to fill out the form correctly

1. Click the ‘Get Form’ button to obtain the Permanent Medical Excusal Form, then open it in your preferred editor.
2. In the first section, enter your full name as it appears on official documents. This ensures your identity is correctly matched to your jury summons.
3. Next, input your juror number, which can be found on the jury summons you received. This number is essential for linking your request to your juror status.
4. Fill in your current address, providing the complete details to ensure accurate communication from the court.
5. Indicate your report date. This is the date you were originally scheduled to appear for jury duty.
6. Provide the contact details of your healthcare provider, including their name, office phone number, and fax number. This information will help verify your request.
7. Ensure that the healthcare provider signs the form. This signature affirms the medical condition described prevents you from serving on a jury.
8. Have the healthcare provider print their name and Florida license number. These are necessary for validation.
9. Finally, indicate the date the form is being completed. This helps to establish a timeline for processing your request.
10. Once all sections are filled out, you can save your changes, download the form, print it out, and share it with the necessary parties via email to juryduty@escambiaclerk.com.

Take action now to complete your Permanent Medical Excusal Form online.