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NJ Jury Duty Medical Excuse Form CN 12308

When a summoned New Jersey juror asks to be excused for medical reasons, a licensed doctor completes this one-page Judiciary certification. The physician attests to examining the patient and checks how long the patient cannot serve, from 3 months to over 12 months. The county Jury Management Office then decides the excusal without receiving any diagnosis.

Who completes it

The licensed physician completes and signs the whole form, entering practice details and license number plus the juror's name, county, candidate ID and summons date from the summons. The juror completes the juror qualification questionnaire separately before requesting the excusal.

Submitting and payment

How to submit it
The completed certification is mailed or emailed to the county Jury Management Office that issued the summons. The court contacts the juror if it needs more information.
Who pays
The Judiciary sets no fee or billing code for the certification.

Good to know

  • The form tells physicians not to write, attach or provide any private health information; the Jury Management Office will never request it.
  • The Judiciary's excusal page says the condition must prevent jury service and be unlikely to change within a year.
  • The physician must also check whether the patient is not employed, or is employed but serving would be more detrimental than their normal work, and explain why.
  • Separate certifications cover financial hardship (CN 12255), caring for a minor child (CN 12140) and nursing mothers (CN 13343). Caring for a dependent needs a doctor's letter instead.

Get the official form

Download the current version from the source each time; forms change without notice.

Physician Certification in Support of Medical Excuse Request

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Should I list the diagnosis on New Jersey's CN 12308?

No. The form tells physicians not to write, attach or otherwise provide private health information, and the Jury Management Office will never request it. You attest that you examined the patient, check how long they cannot serve, and sign. The court may ask for other non-private information if needed.

Can a physician get a New Jersey juror permanently excused?

The form says the Judiciary relies on disability determinations made by the Social Security Administration and the Department of Veterans Affairs, and by physicians, to permanently excuse a juror. The physician can check over 12 months or Other. Questions on permanent medical excusals go to the county Jury Management Office.

Where do I send the NJ physician certification for jury duty?

To the Jury Management Office of the county that issued the summons, by mail or email. The juror should complete the juror qualification questionnaire before the excusal request is sent. Contact details for each county are on the Judiciary's Jury Management contact list.