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Administrative — Jury Duty Excuse Letter

Administrative Primary Care Updated: 1/4/2026

Formal medical excuse letter for jury duty exemption. Document medical conditions that prevent service. For physicians and providers.

Template

[Date]

To the Jury Commissioner: Re: Jury Service for [Patient Name] DOB: [Patient DOB] Juror ID: [Juror ID Number]

To Whom It May Concern,
I am the treating physician for [Patient Name]. This letter is to verify that the patient suffers from a medical condition that [temporarily/permanently] prevents them from serving on a jury.

Nature of Limitation:

[Patient Name] has a condition that causes [severe chronic pain / cognitive impairment / mobility issues / need for frequent medical treatments] which would make sitting for prolonged periods or concentrating on proceedings impossible.

Duration:

This excusal is requested for a period of [Duration, e.g., 6 months / 1 year / Permanently].
Please feel free to contact my office if further verification is required.
Sincerely,
[Provider Name, MD/DO/NP/PA]
[NPI Number]
[Practice Name & Phone Number]

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