Fillable 1. Employee's Name: 2. Patient's Name (if different from employee ... - cs ny

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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) : 3 . The attached sheet describes what is meant by a "serious health condition" under the Family and Medical Leave Act . Does the patient's condition' qualify under any of the categories described? If so,...
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