Massachusetts has no fill-in form for medical disqualification from jury duty: the Office of Jury Commissioner publishes sample letters for the patient's doctor to follow. The letter states that a condition prevents the patient from serving, judged against the ability to do sedentary, attentive work for 6 hours a day over 3 consecutive days, under G.L. c. 234A, s. 4.
The patient's doctor writes the whole letter on office letterhead, following the OJC's sample letter for a standard disqualification or the separate sample for a permanent one.
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Sample Letter - Medical Disqualification / Sample Letter - Permanent Medical Disqualification
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No. The Office of Jury Commissioner asks only for the nature of the medical condition, for example 'mobility impairment' or 'chronic psychiatric condition' rather than a named disease. The letter must be on office letterhead and include the juror's address and, if possible, the badge number.
A standard medical disqualification is valid for 3 years and is meant for temporary impairments or conditions that will improve. A permanent disqualification is valid for the juror's lifetime, but it must use the specific language in the OJC's permanent sample letter.
The standard sample has the physician state that they treat the juror for a described general condition, that in their opinion the condition prevents the juror from performing juror service, and ask the OJC to disqualify the juror, followed by the physician's signature and printed name.