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Attachment B Policy Bulletin No. 95 01-Page 1 of 4 Certification of Health Care Provider (Family and Medical Leave Act of 1993) 1. Employee's Name : 2. Patient's Name (if different from employee)
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To fill out 1 employee's name 2, start by gathering the necessary information such as the employee's first name, last name, and any middle names or initials.
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Begin by writing the employee's first name in the designated field or space provided on the form. Ensure that you spell it correctly and use proper capitalization.
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Next, move on to the employee's last name. Write it in the appropriate section, making sure to accurately spell the last name and use proper capitalization.
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If the form requires it, include any middle names or initials that the employee may have. Write them in the designated space, maintaining proper spelling and capitalization.
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Double-check that you have accurately filled out the employee's name before submitting the form. It is essential to ensure accuracy and avoid any potential complications.

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Employers or organizations that require employee information for payroll processing, record-keeping, or identification purposes need the 1 employee's name 2. This could include HR departments, payroll administrators, or even government agencies.
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Employees themselves may need to fill out their own names in certain situations, such as when completing job applications, tax forms, or other official documents.
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Additionally, external entities such as banks, insurance companies, or healthcare providers may require an employee's name for account setup or verification purposes.
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