Get Pdffmla-cfra Medical Certification Form65.26 Kb

Completing the PdfFMLA-CFRA Medical Certification Form is an important step in requesting leave under the Family and Medical Leave Act and the California Family Rights Act. This guide will provide you with clear, step-by-step instructions to help you fill out the form accurately and efficiently online.

Follow the steps to complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the employee's name in the designated field. Ensure the spelling is correct to avoid any issues.
3. If the patient is different from the employee, enter the patient's name in the provided field.
4. Fill in the date when the medical condition or need for treatment started.
5. Indicate the probable duration of the medical condition or need for treatment.
6. Answer the question regarding whether the patient's condition qualifies under any of the categories described by marking 'Yes' or 'No'.
7. If the certification pertains to the employee's serious health condition, answer the questions regarding the employee's ability to perform work and provide details about required reduced schedules or intermittent leave.
8. If the certification is for a family member, outline the relationship and provide necessary details on how often leave will be required.
9. In the space provided, confirm if the patient requires assistance for basic needs by marking 'Yes' or 'No'.
10. Add any additional comments that may support the claim.
11. Both the health care provider and the employee should sign and date the form in the designated areas.
12. Once completed, save your changes, and consider downloading, printing, or sharing the form as necessary.

Start filling out your PdfFMLA-CFRA Medical Certification Form online today.