Jeffrey A. Collins
Senior Vice-President/Area Manager
Varoujan Altebarmakian, MD
Medical Group Administrator
Kaiser Permanente Fresno Medical Center
7300 North Fresno Street
Fresno, California 93720-2942
Jury Duty Medical Excuse Form
This is to inform you that the patient listed above has been excused from Jury Duty due to this
__________________________ Could serve at a later date.
__________________________ Should never serve.
Signature of Attending Physician