Get Medical Leave Forms

Filling out the Medical Leave Forms online can feel overwhelming, but with clear instructions, you can navigate the process smoothly. This guide will help you complete each section of the form accurately and efficiently.

Follow the steps to successfully complete your Medical Leave Forms online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing your personal details. This includes your full name, Social Security Number (partial), phone number, address, city, state, zip code, date of birth, job title, department name, and email address for communication with Human Resources (HR). Ensure all fields are completed accurately.
3. In the section labeled ‘Reasons for leave of absence,’ check the box that corresponds to your reason for taking medical leave. Options include birth/care of a newborn, health condition, covered service member injury, qualifying exigency, placement/adoption/foster care, or health condition related to a family member.
4. If applicable, indicate whether your medical leave is intermittent by checking ‘Yes’ and provide estimates for frequency and duration. Then, fill in the start and end dates for your requested leave.
5. Select the benefits that you wish to continue during your unpaid FMLA leave. Options include medical insurance, life insurance, personal accident insurance, dental insurance, and long-term disability.
6. If you want to use accrued vacation days or personal holidays during your FMLA leave, fill in the corresponding fields with the number of days you wish to use.
7. Carefully review the University’s FMLA policy. After reviewing, affirm that the information you have provided is accurate by signing and dating the form. Ensure you do not provide your medical details to your supervisor.
8. Once completed, submit the form to your supervisor for their signature, followed by submission to HR Leave Administration. Ensure you have the Certification of Health Care Provider form completed without submitting it to your supervisor.
9. Final step: Save your changes, then download, print, or share the completed form as needed.

Take the necessary steps to obtain and complete your Medical Leave Forms online today.