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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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How to fill out certification of health care

01
Obtain the certification of health care form from the appropriate health care provider or organization.
02
Fill out your personal information such as name, date of birth, and contact information.
03
Provide information about your current health status, any medical conditions, and medications you are taking.
04
Answer any questions about recent hospitalizations, surgeries, or treatments.
05
Have the form signed and stamped by the health care provider or organization.
06
Make sure all information provided is accurate and up to date.

Who needs certification of health care?

01
Individuals who are applying for certain jobs that require proof of good health.
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People who are planning to travel to certain countries that require a health certificate.
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Students who need to provide proof of medical clearance for participation in sports or other activities.
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Patients who are undergoing medical procedures or treatments that require certification of health care.
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Certification of health care is a document used to verify an individual's medical condition or need for medical treatment.
Certification of health care is typically filed by individuals seeking medical treatment or by their healthcare providers.
Certification of health care can be filled out by providing detailed information about the individual's medical condition, treatment plan, and healthcare provider.
The purpose of certification of health care is to ensure that individuals receive necessary medical treatment based on their medical condition.
Information such as the individual's medical history, current medical condition, treatment plan, and healthcare provider must be reported on certification of health care.
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