Employee and Retiree Service Center MONTGOMERY COUNTY PUBLIC SCHOOLS Rockville, Maryland 20855 CERTIFICATION OF PHYSICIAN OR HEALTH CARE PROVIDER PART I: PATIENT INFORMATION To be completed by employee.

How it works
  • Open form

    Open form follow the instructions

  • Easily sign form

    Easily sign the form with your finger

  • Share form

    Send filled & signed form or save

How to fill out the Mcps Form 440 35 online

This guide will assist you in accurately completing the Mcps Form 440 35 online, which is essential for certifying health conditions pertaining to employees. Follow the outlined steps to ensure a smooth submission process.

Follow the steps to complete the Mcps Form 440 35 efficiently.

  1. Click the ‘Get Form’ button to access the form and open it in your online editing tool.
  2. Begin by filling out Part I, which includes the patient information. Provide details such as the employee's last name, first name, middle initial, and employee number. Ensure you enter the date in the format required.
  3. Proceed to Part II for the certification relating to the employee's own serious health condition. The physician or healthcare provider should specify the estimated dates of absence, ensuring they align with the leave period. Include treatment details such as the number of visits and the general nature of the regimen prescribed.
  4. In this section, indicate any necessary information about the employee's health condition, including the date the condition started, diagnosis, and whether hospitalization is required. Clearly state if the employee is able to perform their job functions after considering essential functions outlined by the employer.
  5. If applicable, provide details about the estimated delivery date if the absence is related to pregnancy.
  6. Move to Part III, which pertains to care for a seriously ill family member. The healthcare provider should include the relationship of the employee to the family member, along with the estimated absence dates.
  7. Answer the questions about the family member's medical needs, indicating if hospitalization is necessary, and whether assistance is required for basic needs. Highlight the importance of the employee’s presence for the patient’s care.
  8. Finish with Part IV, which requires the physician or healthcare provider's authorization. Enter the printed name, phone number, signature, and the date. Specify the type of practice or field of specialization.
  9. Review all entries for accuracy, and utilize the options available to save changes. You may then download, print, or share the completed form as needed.

Complete your Mcps Form 440 35 online today to ensure timely processing of your health certification.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Related content

Montgomery County Public Schools Workers'...

Apr 5, 2019 — MCPS Workers Compensation Program and Process ... 4a: Eliminate redundant...

Learn more
Student Name - Montgomery Blair High School

The forms are available in the attendance office and must be approved by an ... one during...

Learn more
general information guide - Mitelservice

No part of this document can be reproduced or transmitted in any form or by any means...

Learn more
Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

How do I contact the help desk of Montgomery County Schools?

For more information, please contact the Technical Help Desk at 301-517-5800.

What will I need to provide to access the information? Montgomery County Public Schools Code 10454. Your social security number (Do not include dashes.) The number to call for express verification 1-800-367-5690.

Board of Education Contact Information Telephone: 240-740-3030. Fax: 301-279-3860. Email: boe@mcpsmd.org. All messages sent to this address will be automatically copied to all Board members.

MCPS Numbers OfficePhone Number General Information—MCPS Call Center (AskMCPS) 240-740-3000 Help Desk 301-517-5800 Human Resources and Development (personnel services) 301-279-3940 International Admissions and Enrollment (residency) 240-740-450049 more rows

CALL 240-740-3000.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

If you believe that this page should be taken down, please follow our DMCA take down process here.

Get Mcps Form 440 35