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Certification of Health Care Provider for Employees Serious Health Condition (Family and Medical Leave Act)U.S. Department of Labor Wage and Hour Division DO NOT SEND COMPLETED FORM TO THE DEPARTMENT

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What is certification of health care?

Certification of health care is a document that verifies an individual's health condition and may be required for various purposes such as eligibility for certain benefits or accommodations.

Who is required to file certification of health care?

Individuals who need to provide proof of their health status or condition for specific purposes may be required to file certification of health care.

How to fill out certification of health care?

To fill out certification of health care, individuals may need to provide information about their health condition, medical history, and any relevant medical documentation as requested.

What is the purpose of certification of health care?

The purpose of certification of health care is to provide a documented verification of an individual's health status or condition for various purposes such as medical treatment, insurance claims, or legal proceedings.

What information must be reported on certification of health care?

The information reported on certification of health care may include details about the individual's health condition, medical history, treatment plan, and any relevant medical documentation as requested.

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