Request For Medical Excuse From Jury Duty {JUR001} | Pdf Fpdf Docx | California

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Request For Medical Excuse From Jury Duty {JUR001} | Pdf Fpdf Docx | California

Last updated: 9/11/2023

Request For Medical Excuse From Jury Duty {JUR001}

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JUR001 - REQUEST FOR MEDICAL EXCUSE FROM JURY DUTY. If you are requesting to be excused from jury duty because of a medical incapacity, or you are an “Authorized representative” of a person scheduled for jury duty with a medical incapacity, complete the information on this form and submit the request for medical excusal with a supporting letter, memo or note from a treating health care provider. The supporting document must be on the treating health care provider’s letterhead, state that the person has a temporary or permanent disability that makes the person incapable of performing jury service, and be signed by the provider. The completed form, along with the health care provider's supporting document, must be returned to the court by mail, fax, or email at least five (5) business days prior to the appearance date. The court will then review the request and notify the requester as to whether the request for excusal is approved or denied.

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