01. Edit your request disqualification jury online
Type text, add images, blackout confidential details, add comments, highlights and more.
REQUEST FOR MEDICAL DISQUALIFICATION FROM JURY SERVICE 2026
Here's how it works
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send jd ja 47 via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out REQUEST FOR MEDICAL DISQUALIFICATION FROM JURY SERVICE
Ease of Setup
DocHub User Ratings on G2
Ease of Use
DocHub User Ratings on G2
- Click ‘Get Form’ to open it in the editor.
- In Part I, enter your name, address, and juror identification number. Ensure all information is accurate to avoid delays.
- Provide your date of birth and clearly state your claim for disqualification due to physical or mental disability.
- Next, print the form and have a licensed health care provider complete Part II. They must provide their opinion on your ability to serve as a juror.
- Ensure that the health care provider selects whether you should be disqualified for one year or permanently. This section must be legible for processing.
- Once completed, save the document and either fax it to Jury Administration at (860) 263-2770 or email it to Jury.Administration@jud.ct.gov. You may also mail it directly.
Start using our platform today to easily fill out and submit your REQUEST FOR MEDICAL DISQUALIFICATION!
See more request disqualification jury versions
We've got more versions of the request disqualification jury form. Select the right request disqualification jury version from the list and start editing it straight away!
Security and compliance
At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.
Related links
May 16, 1988 It is the purpose of these rules to establish procedures for handlin!l personnel activities and transactions provided for in the State Merit.Read more
To request a medical disqualification, fill out Part I of this form and have a licensed health care provider complete Part II. Do not take this request toRead more
by A Offit Cited by 5 (jury commissioner may request a letter from a licensed medical professional for disqualification);