Get the free FMLA Certification Form - California Lutheran University - callutheran

CERTIFICATION OF PHYSICIAN OR PRACTITIONER (Family and Medical Leave Act of 1993/California Family Rights Act of 1993) Return to: Human Resources California Lutheran University 60 W. Olsen Rd. Thousand

How to fill out fmla certification form

How to fill out FMLA certification form:

1. Obtain the FMLA certification form from your employer or human resources department. They should provide you with the necessary form.
2. Read through the form carefully and make sure you understand all the instructions and requirements.
3. Fill in your personal information, including your name, address, and contact information. Provide your employee identification number if applicable.
4. Specify the start and end dates of your requested FMLA leave. Indicate whether it will be continuous or intermittent.
5. Include the reason for your FMLA leave. This could be your own serious health condition, a family member's serious health condition, the birth or adoption of a child, or to care for a covered servicemember with a serious injury or illness.
6. If your leave is due to a medical condition, have your healthcare provider complete the relevant section certifying the need for FMLA leave. Your provider will need to provide details about your condition, including diagnosis, treatment plan, and expected duration of the leave.
7. If your leave is to care for a family member, ensure that their healthcare provider completes the necessary section certifying their condition and the need for your caregiving.
8. Review the completed form for accuracy and ensure all required sections are filled out appropriately.
9. Sign and date the form, and submit it to your employer or human resources department as instructed.

Who needs FMLA certification form:

1. Employees who require a leave of absence under the Family and Medical Leave Act (FMLA) may need to complete the FMLA certification form.
2. This form is necessary to request and document FMLA leave, whether it is for the employee's own serious health condition, the care of a family member, or other qualifying reasons.
3. The FMLA certification form provides both the employee and the employer with a clear record of the need for leave and helps ensure compliance with FMLA regulations.

For pdfFiller’s FAQs

What is fmla certification form?

The FMLA certification form, also known as Form WH-380-E, is a document used by employees to provide medical certification of a serious health condition that qualifies for FMLA leave.

Who is required to file fmla certification form?

Both employees and their family members seeking FMLA leave are required to file the FMLA certification form. It is used to establish the need for leave due to a serious health condition.

How to fill out fmla certification form?

To fill out the FMLA certification form, the employee or their family member should provide their personal information, details about the medical condition, the healthcare provider's information, and any additional information requested on the form.

What is the purpose of fmla certification form?

The purpose of the FMLA certification form is to certify the need for FMLA leave due to a serious health condition. It helps employers verify the need for time off and ensures compliance with the FMLA regulations.

What information must be reported on fmla certification form?

The FMLA certification form requires information such as the employee's or family member's name, contact details, the healthcare provider's information, a description of the medical condition, the duration of the condition, and whether intermittent leave is necessary.

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