Request For Medical Disqualification From Jury Service {JD-JA-47}

JD-JA-47 - REQUEST FOR MEDICAL DISQUALIFICATION FROM JURY SERVICE. This is a Connecticut Judicial Branch form used by jurors seeking exemption from jury duty due to a physical or mental condition. The juror completes Part I, and a licensed health care provider must complete Part II to certify that the individual is unable to perform the duties required of jury service. The provider may recommend either a temporary or permanent disqualification based on the individual’s condition. The completed form is submitted directly to Jury Administration for review, and the court will notify the juror of its decision. C.G.S. § 51-217(a)(9), (c)(1). www.FormsWorkflow.com