Get the free PER0166 FML Medical Certification Statement Rev 08-2012doc

St. Lucie Public Schools, Ft. Pierce, Florida MEDICAL CERTIFICATION STATEMENT This certification is for the illness of the SLC employee. Name: This certification is for the illness of the SLC employees

How to fill out per0166 fml medical certification

How to fill out per0166 FML medical certification:

1. Start by downloading the per0166 FML medical certification form from the appropriate website or obtaining a physical copy from your employer or human resources department.
2. Read the instructions carefully to understand the requirements and criteria for the certification.
3. Fill out the employee's personal information section, including their name, social security number, job title, and department.
4. Provide details about the medical condition that necessitates the employee's absence from work. Include the date of onset, the expected duration of the condition, and any relevant medical documentation or diagnosis.
5. Indicate whether the employee requires a reduced work schedule, intermittent leave, or a continuous absence.
6. If applicable, specify the number of hours or days per week the employee will be able to work.
7. If the employee's condition requires intermittent leave, indicate the frequency and duration of each absence.
8. Provide the employee's healthcare provider's information, including their name, contact details, and professional credentials.
9. The healthcare provider should complete the medical certification section, including providing an opinion on the employee's ability to perform essential job functions, any necessary accommodations, and the expected date of the employee's return to work.
10. Make sure both the employee and healthcare provider sign and date the form.
11. Submit the completed per0166 FML medical certification form to the appropriate party, such as your employer or human resources department.

Who needs per0166 FML medical certification:

1. Employees who require leave under the Family and Medical Leave Act (FMLA) due to a serious health condition.
2. Employees requesting time off for their own medical condition that qualifies for FMLA leave.
3. Individuals serving as healthcare providers for employees who need their medical condition certified for FMLA leave.

Note: It is advisable to consult with your employer or human resources department to ensure you are following the correct procedures and using the most up-to-date version of the per0166 FML medical certification form.

For pdfFiller’s FAQs

What is per0166 fml medical certification?

per0166 fml medical certification is a form used to certify the medical condition of an employee or their family member for the Family and Medical Leave Act.

Who is required to file per0166 fml medical certification?

Employees or their family members who need to take leave under the Family and Medical Leave Act are required to file per0166 fml medical certification.

How to fill out per0166 fml medical certification?

To fill out per0166 fml medical certification, the employee or their family member must provide their medical information and have a healthcare provider certify the need for leave.

What is the purpose of per0166 fml medical certification?

The purpose of per0166 fml medical certification is to verify the medical need for leave under the Family and Medical Leave Act.

What information must be reported on per0166 fml medical certification?

per0166 fml medical certification must include the employee or family member's medical condition, the expected duration of leave, and the healthcare provider's certification.

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