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Mail to:Medical Fitness Review Units. O. Box 173 Trenton, New Jersey 086660173 Email to: MVCMedicalReview@mvc.nj.govMEDICAL EMERGENCY REPORT Please print or typePatients NameAddressDate of Birthfirstm.i.streetcityEye

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How to fill out request for medical exemption

01

Obtain a medical certificate from a licensed healthcare provider explaining the medical condition that requires an exemption

02

Complete the request form provided by the organization requesting the exemption

03

Attach the medical certificate to the request form

04

Submit the completed form and medical certificate to the appropriate individual or department as instructed

Who needs request for medical exemption?

01

Individuals who have a documented medical condition that contraindicates certain medical procedures or treatments

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What is request for medical exemption?

Request for medical exemption is a formal application submitted to request an exemption from certain medical requirements.

Who is required to file request for medical exemption?

Any individual who believes they are eligible for a medical exemption is required to file a request for medical exemption.

How to fill out request for medical exemption?

To fill out a request for medical exemption, you must provide all required information and documentation as outlined in the application form.

What is the purpose of request for medical exemption?

The purpose of a request for medical exemption is to seek an exemption from certain medical requirements based on medical reasons or conditions.

What information must be reported on request for medical exemption?

The request for medical exemption must include information about the individual's medical condition, supporting documentation, and any other relevant details.

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