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Physician Medical Excuse For Jury Duty Template - Web request for medical excuse from jury service a.r.s. Try it for free now! Please excuse the above named patient from federal jury duty due to: _____ _____ _____ it is medically advisable that the patient refrain. _____ _____ _____ _____ it is medically. Upload, modify or create forms. You must also return your completed. Physician's statement for medical excuse from. _____ _____ _____ name of physician: Web if you are physically and/or mentally unable to appear for jury service, have your physician complete the following (all of the.

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