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This document is used to certify an employee's serious health condition for leave under the Family Medical Leave Act (FMLA). It requires the employee to provide their details and for a health care

How to fill out certification of health care

How to fill out Certification of Health Care Provider for Employee’s Serious Health Condition (Family Medical Leave Act)

1. Obtain the Certification of Health Care Provider form from your employer or download it from the Department of Labor's website.
2. Complete the employee’s information section, including the employee's name, address, and other personal details.
3. Have the healthcare provider fill out their information, including their name, contact information, and type of medical practice.
4. Instruct the healthcare provider to specify the medical condition that qualifies as a serious health condition.
5. Ensure that the healthcare provider indicates the expected duration of the condition and any treatments that may be required.
6. Include any information regarding the employee’s ability to perform their job functions and any accommodations that may be necessary.
7. Review the completed form for accuracy and completeness before submitting it to your employer.
8. Provide the form to your HR department or designated contact person as instructed by your employer’s policies.

Who needs Certification of Health Care Provider for Employee’s Serious Health Condition (Family Medical Leave Act)?

1. Employees who have a serious health condition that makes them unable to perform the functions of their job.
2. Employees who need to take leave to care for a family member with a serious health condition.
3. Employees who are using Family Medical Leave Act (FMLA) benefits for their own health issues or a family member's health issues.

For pdfFiller’s FAQs

What is Certification of Health Care Provider for Employee’s Serious Health Condition (Family Medical Leave Act)?

The Certification of Health Care Provider is a form used by employers under the Family Medical Leave Act (FMLA) to verify an employee's serious health condition. The form is completed by the employee's health care provider and provides information on the condition and the need for leave.

Who is required to file Certification of Health Care Provider for Employee’s Serious Health Condition (Family Medical Leave Act)?

The employee who is taking leave under the FMLA due to their own serious health condition or to care for a family member with a serious health condition must file the Certification of Health Care Provider.

How to fill out Certification of Health Care Provider for Employee’s Serious Health Condition (Family Medical Leave Act)?

To fill out the form, the health care provider must complete sections detailing the employee's health condition, the treatment plan, the expected duration of the condition, and any necessary leave periods. The employee should provide the form to their health care provider.

What is the purpose of Certification of Health Care Provider for Employee’s Serious Health Condition (Family Medical Leave Act)?

The purpose of the Certification is to confirm the legitimacy of the employee's serious health condition and the need for medical leave. It helps ensure that leave is taken for approved reasons under the FMLA.

What information must be reported on Certification of Health Care Provider for Employee’s Serious Health Condition (Family Medical Leave Act)?

The information reported includes the nature of the serious health condition, the start and expected end dates of the condition, the necessity for leave, and any limitations on the employee's ability to work.