FMLA Certification of Health Care Provider form for a Family Member's Serious Health Condition

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Employees provide their University leave administrator a completed federal Department of Labor's Family Medical Leave Act (FMLA) Certification of Health Care Provider form for a Family Member's Serious Health Condition when they may be absent from work (full-time, part-time or intermittently) to care for a family member who is experiencing may be a serious health condition.

This form is used as part of the University's leave application process regardless of if the employee is FMLA-eligible for consistency purposes & is provided on the University's website due to difficulty customers have experienced downloading it from the US DOL FMLA website.