Get Physician's Statement For Medical Excuse From Jury Service

This guide provides a comprehensive overview of how to complete the Physician's Statement For Medical Excuse From Jury Service online. Whether you are a physician or a patient, you'll find clear, step-by-step instructions to help ensure that the form is filled out correctly.

Follow the steps to complete the form correctly.

1. Select the ‘Get Form’ button to obtain the Physician's Statement for Medical Excuse From Jury Service and open it in your online editing platform.
2. In the field labeled 'Juror’s Participant Number,' enter the unique code associated with the juror. This number is crucial for identifying the individual requesting the medical excuse.
3. In the 'Patient Name' section, clearly write the full name of the individual who is requesting the medical excuse.
4. Fill in the 'Patient Address' field with the current residential address of the patient. Make sure to include all necessary details, such as street address, city, state, and zip code.
5. For the reason for the medical excuse, write a detailed explanation in the provided section. Clearly articulate the medical condition or circumstances that prevent the patient from serving on jury duty.
6. If applicable, explain in the next section why serving on the jury would be more detrimental to the patient than their regular employment. This is important for providing context to the Federal Jury Clerk.
7. If a temporary excuse from jury service is being requested, provide the necessary details in the corresponding field. Specify the duration and reason for the temporary excuse.
8. In the 'Name of Physician' section, the physician should print their name clearly to ensure that the form is valid.
9. Fill in the physician's address and telephone number to facilitate any necessary follow-up communication.
10. Enter the physician's license number in the designated field, ensuring that it is accurate.
11. The physician must then sign the form and include the date of signature in the specified areas. This verification is essential for the legitimacy of the request.
12. Once all fields are complete, review the form for accuracy. After making any necessary adjustments, save the changes, and choose an option to download, print, or share the completed form as needed.

Complete your Physician's Statement for Medical Excuse From Jury Service online today to ensure a smooth submission process.