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FMLA CERTIFICATION FOLLOW-UP FORM Patient Date The person named above was seen in my office on, 200. As a result of that visit, it is my determination that he/she: Is unable to return to work at this

How to fill out fmla certification follow-up form

The FMLA Certification Follow-Up Form is typically required for employees who have already submitted an initial FMLA certification form and need to provide additional information or extend their leave under the Family and Medical Leave Act (FMLA).

To fill out the FMLA Certification Follow-Up Form, follow these steps:

1. Start by entering your personal information, such as your name, employee ID, and contact details. Make sure to provide accurate information to avoid any delays or confusion.
2. Next, indicate the exact dates of your original FMLA leave and specify the reason for your absence. This could include medical treatment, a chronic health condition, caregiving responsibilities, or the birth/adoption of a child. Be specific and provide any necessary supporting documentation.
3. In the form, describe any changes in your condition or circumstances since the initial FMLA certification. Highlight any developments that may require an extension of your leave or a modification to the original certification.
4. If you have received medical treatment during your leave, include the name and contact information of the healthcare provider. This will help your employer or the FMLA administrator to verify the information provided and seek any necessary clarifications.
5. Additionally, if your leave impacts your ability to perform certain job duties or requires any accommodation, clarify this in the form. Include any supporting documentation, such as a medical note or letter from a healthcare professional.
6. Lastly, sign and date the FMLA Certification Follow-Up Form. Ensure that you understand and agree to the information provided. Keep a copy of the completed form for your records and submit the original to your employer or the designated FMLA administrator.

For pdfFiller’s FAQs

What is fmla certification follow-up form?

FMLA certification follow-up form is a document used to update an employee's existing FMLA certification with additional information or updates.

Who is required to file fmla certification follow-up form?

Employees who are on FMLA leave and need to provide updated information or extend their leave are required to file FMLA certification follow-up form.

How to fill out fmla certification follow-up form?

FMLA certification follow-up form can be filled out by the employee or their healthcare provider and should include any new information related to the employee's medical condition or treatment.

What is the purpose of fmla certification follow-up form?

The purpose of FMLA certification follow-up form is to ensure that the employer has the most up-to-date information regarding the employee's medical condition and FMLA leave status.

What information must be reported on fmla certification follow-up form?

FMLA certification follow-up form must include details on the employee's current medical condition, any changes in the treatment plan, and the expected duration of the FMLA leave extension.

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