BOUNDARY COUNTY DOCTORS CERTIFICATE FOR RELEASE FROM JURY DUTY
I HEREBY CERTIFY that________________________________________
(print full name of patient)
1._______Is a patient under my care and that said patient suffers from a chronic physical condition or state of health that would make serving as a juror dangerous to the patient's health or personally embarrassing to the patient.
NOTE TO THE PHYSICIAN: Option 1 (above) will excuse a juror from the Jury Panel that they were selected for. They will be excused for a time frame of up to 2 years. A prospective Juror may request a postponement directly from the Jury Commissioner for temporary medical circumstances such as pregnancy, broken bones, surgery or recovery. A medical certificate is not required for those circumstances. Please be aware that we have advanced hearing assistance equipment in our court rooms. Jurors may stop by to evaluate this equipment for hearing loss conditions.
2._______Is a patient under my care and that said patient suffers from a permanent physical condition or state of health that would make serving as a juror impossible for the patient. I request that the patient be excused from Jury duty for ____________________. (please indicate length of time)
Pursuant to Idaho Code 2-209 (1) (b), this request is based on the following medical condition that renders the prospective juror incapable of performing satisfactory jury service:
PHONE NUMBER__________________ PRINTED NAME_______________________M.D.
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The above named Juror shall be excused from Jury Service for a period of ___________.
DATED _________________ JUDGE ___________________________________