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PIGS 2002D July 1, 2020U of A System Division of Agriculture Catastrophic Leave Bank Program Physicians Certification Part I (Completed by Employee) Employee Name: (Print) LastFirstMiddleCity/StateZipAddress:
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How to fill out catastrophic-leave-bank-physician-certification-formpdf
How to fill out catastrophic-leave-bank-physician-certification-formpdf
01
Obtain the catastrophic-leave-bank-physician-certification-formpdf from your human resources department or download it from the company's website.
02
Fill in your personal information, including your name, employee ID, and contact information.
03
Provide details about the reason for your leave and the duration of leave requested.
04
Have your physician or healthcare provider fill out the required sections, including information about your medical condition and the expected duration of your absence.
05
Review the form for accuracy and completeness before submitting it to your employer.
Who needs catastrophic-leave-bank-physician-certification-formpdf?
01
Employees who need to take a leave of absence due to a catastrophic event or medical condition and wish to utilize the catastrophic leave bank program.
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What is catastrophic-leave-bank-physician-certification-formpdf?
It is a form used to certify a physician's recommendation for an employee to access catastrophic leave bank.
Who is required to file catastrophic-leave-bank-physician-certification-formpdf?
Employees who need to access catastrophic leave bank are required to file this form.
How to fill out catastrophic-leave-bank-physician-certification-formpdf?
The form needs to be completed by the employee and their physician, providing necessary medical information and recommendations.
What is the purpose of catastrophic-leave-bank-physician-certification-formpdf?
The purpose of the form is to certify the medical need for an employee to access catastrophic leave bank.
What information must be reported on catastrophic-leave-bank-physician-certification-formpdf?
The form requires medical information, including the diagnosis, treatment plan, and recommendation for the employee's need for catastrophic leave.
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