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HUMAN RESOURCES DEPARTMENT 127 East Oak Street, Juneau, WI53039 9203863690 Fax 9203863545 MEDICAL CERTIFICATION SPOUSE / CHILD / PARENT Name of Patient/Relationship to Employee: Name of Dodge County
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What is medical certification form for?
The medical certification form is used to provide documentation of an individual's medical condition.
Who is required to file medical certification form for?
Individuals who require medical accommodations or leave due to health reasons are required to file a medical certification form.
How to fill out medical certification form for?
The medical certification form should be filled out by the individual's healthcare provider with all necessary medical information and documentation.
What is the purpose of medical certification form for?
The purpose of the medical certification form is to provide official documentation of an individual's medical condition for accommodations or leave.
What information must be reported on medical certification form for?
The medical certification form must include the individual's diagnosis, treatment plan, and any necessary restrictions or accommodations.
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