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CERTIFICATION FOR SERIOUS INJURY OR ILLNESS OF A VETERAN FOR MILITARY CAREGIVER LEAVE (FAMILY AND MEDICAL LEAVE ACT) Adapted from Form WH385V Revised June 2020 Expires 6/30/2023SECTION EMPLOYER Either

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How to fill out certification for serious injury

01

Obtain the certification form for serious injury from the relevant authority or organization.

02

Fill in your personal information such as your name, address, and contact details in the designated fields.

03

Provide detailed information about the injury, including the date, time, and location of the incident.

04

Describe the nature and extent of the injury, providing as much detail as possible.

05

If applicable, include any medical reports, X-rays, or test results related to the injury.

06

Sign and date the certification form, certifying that the information provided is true and accurate.

07

Submit the completed certification form to the appropriate authority or organization as per their instructions.

Who needs certification for serious injury?

01

Individuals who have sustained a serious injury and require official certification to support their claims or medical treatment may need to fill out a certification for serious injury.

02

These individuals may include accident victims, patients seeking compensation, employees filing for workers' compensation, and individuals involved in legal proceedings related to the injury.

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What is certification for serious injury?

Certification for serious injury is a document that confirms and verifies an individual has suffered a serious injury.

Who is required to file certification for serious injury?

The individual who has suffered a serious injury or their authorized representative is required to file the certification for serious injury.

How to fill out certification for serious injury?

The certification for serious injury should be filled out with accurate information about the injury, including details about the event, the nature of the injury, and any medical treatment received.

What is the purpose of certification for serious injury?

The purpose of certification for serious injury is to provide documentation of a serious injury for legal or insurance purposes.

What information must be reported on certification for serious injury?

The certification for serious injury must include details about the individual's personal information, the injury itself, any medical treatment received, and any other relevant information.

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