WebThe information on the Certification of Serious Health Condition Form is required when applying for: • Medical leave due to your own serious health condition. • Medical leave due to your own pregnancy/child’s birth. • Family leave to take care of a family member with a serious health condition.

Certification of Health Care Provider for U.S.

WebThe Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued by the employee’s health care provider. 29 U.S.C. §§ 2613, 2614(c)(3); 29 C.F.R. § 825.305. WebWhen leave is for a family member’s serious health condition, the health care provider should complete the "Certification of Health Care Provider for Family Member’s Serious … sunford light

FMLA - Serious Health Condition U.S. Department of …

Webcertification to support a request for FMLA leave due to your own serious health condition. If requested by your employer, your response is required to obtain or retain the benefit of FMLA protections. 29 U.S.C. §§ 2613, 2614(c)(3). Failure to provide a complete and sufficient medical certification may result in a denial of your FMLA WebHealth Care Provider . Employee's Serious Health Condition . Certification of Health Care Provider (Family and Medical Leave Act of 1993 as Amended) Agency Contact Person and phone/email: Employee's Job Title: Regular WorkSchedule: Essential Job Functions: Check if job description is attached . Your Name: Last Name First Name MiddleName/Initial WebFAMILY AND MEDICAL LEAVE EMPLOYEE PACKET A Leave for: 1. Serious health condition of employee or family member 2. Parental leave 3. Sick Child leave 4. Bereavement leave DISCLOSURE: Please read this statement before proceeding. This packet is a summary of Family and Medical leave policy and procedures. In all cases … sun for schools