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Juror Name:___ DOB:___Juror Disability & Medical Certification Form Your response to the juror questionnaire qualified you to serve as a prospective juror with the exception of a disability or medical
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How to fill out juror disability medical certification
How to fill out juror disability medical certification
01
Obtain the juror disability medical certification form from the court or its website.
02
Read the instructions carefully to understand the requirements.
03
Fill out your personal information, including your name, address, and juror number.
04
Provide details about your medical condition that impacts your ability to serve as a juror.
05
Have your healthcare provider complete their section of the form, providing their assessment of your condition.
06
Ensure that the healthcare provider signs and dates the certification.
07
Review the completed form for accuracy and completeness.
08
Submit the form to the court by the specified deadline, either in person or via mail.
Who needs juror disability medical certification?
01
Individuals who have a medical condition or disability that prevents them from serving as a juror.
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What is juror disability medical certification?
Juror disability medical certification is a formal document that provides evidence of a juror's medical condition that prevents them from serving on a jury.
Who is required to file juror disability medical certification?
Individuals who are summoned for jury duty and have a medical condition that hinders their ability to serve are required to file a juror disability medical certification.
How to fill out juror disability medical certification?
To fill out juror disability medical certification, the juror must complete the designated form, providing accurate information about their medical condition, any relevant treatment details, and may need to obtain a physician's signature.
What is the purpose of juror disability medical certification?
The purpose of juror disability medical certification is to formally notify the court of a juror's inability to serve due to medical reasons and to establish grounds for exemption from jury duty.
What information must be reported on juror disability medical certification?
The information that must be reported includes the juror's personal details, a description of the medical condition, duration of the condition, and the treating physician's information.
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