New Jersey Courts Physician Certification for Medical Excusal
This form is a Physician Certification in Support of Medical Excuse Request intended for jurors in New Jersey. It allows physicians to attest to a patient's inability to serve on a jury due to health reasons. The form must be filled out and submitted to the Jury Management Office for review.
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How do I fill this out?
To fill out this form, gather all the necessary information about both the patient and the physician. Ensure that each section is accurately completed with clear and legible handwriting. Review the form before submission to avoid any errors or omissions.
How to fill out the New Jersey Courts Physician Certification for Medical Excusal?
1
Collect the patient's details, including full name and contact information.
2
Fill in the physician's information, including name, contact number, and license number.
3
Indicate the duration for which the patient is unable to serve.
4
Certify the statements made by the physician with a signature and date.
5
Submit the completed form to the Jury Management Office.
Who needs the New Jersey Courts Physician Certification for Medical Excusal?
1
Jurors in New Jersey who have health issues requiring a medical exclusion.
2
Physicians who need to provide certification for their patients regarding jury duty.
3
Legal professionals advising clients unable to serve due to medical reasons.
4
Social workers assisting clients in navigating jury summons and health declarations.
5
Family members who support patients in securing a medical excuse from jury duty.
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What are the instructions for submitting this form?
To submit the Physician Certification form, email it to the Jury Management Office at juryoffice@njcourts.gov, or fax it to (555) 123-4567. You can also mail it to New Jersey Jury Management Office, 123 Court St., Trenton, NJ 08625. Always retain a copy of your submission for your records and follow up if you do not receive confirmation within a week.
What are the important dates for this form in 2024 and 2025?
Be sure to submit your Physician Certification form as soon as possible upon receiving your jury summons. This ensures that your request for excusal is processed in a timely manner. Check if there are any specific deadlines mentioned on your summons.
What is the purpose of this form?
The purpose of this form is to provide a formal request for medical excuse from jury duty. It allows physicians to certify a patient’s inability to serve due to health issues. This process ensures that the Judiciary maintains a fair and balanced jury system while accommodating those with legitimate health concerns.
Tell me about this form and its components and fields line-by-line.
- 1. Physician's Name: The full name of the physician certifying the medical excuse.
- 2. Patient Full Name: The full name of the patient requesting the medical excuse.
- 3. Physician's Office Telephone: Contact number for the physician's office.
- 4. Physician's License Number: The license number of the physician authorized to practice.
- 5. Summons Date: The date on which the juror is summoned for duty.
What happens if I fail to submit this form?
If you fail to submit this form, you may be required to attend jury duty despite your medical condition. This could lead to potential legal consequences for not complying with court orders. It is crucial to submit the form in a timely manner to avoid any complications.
- Legal Obligation: Failure to submit may result in being held in contempt of court.
- Health Risks: Participating in jury duty may exacerbate your medical condition.
- Delay in Processing: Late submissions can slow down the jury selection process.
How do I know when to use this form?
- 1. Medical Inability: For individuals with medical conditions that prevent them from serving.
- 2. Physician's Support: When a physician is willing to certify the medical request.
- 3. Submitting for Review: To formally submit to the Jury Management Office for consideration.
Frequently Asked Questions
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Yes, after editing, you can download the PDF directly to your device.
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You can submit the form via email, fax, or by mail to the designated office.
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You can go back and edit your entries until you are ready to finalize the form.
Do I need to print the form after editing?
You can download a digital copy or print it directly, depending on your preference.
Are there any specific formats for submission?
Check with the Jury Management Office for any specific submission requirements.
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