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Certification of Health Care Provider - Employee's or Family Member's Serious Health Condition
This form is used to obtain physician or medical practitioner certification that the employee or a family member is disabled due to a “serious health condition,” and should be given to employee along with their job description. While you are not required to use this form, you may not ask the employee to provide more information than required under the FMLA/CFRA.
Fill out the form to download this FMLA Certification of Health Care Provider Form!