Get Cornell University Family Leave Provider Verification Form 2017-2025

Filling out the Cornell University Family Leave Provider Verification Form is a crucial step for employees seeking family health leave. This guide will provide you with detailed instructions on how to complete the form accurately and efficiently online.

Follow the steps to complete your family leave provider verification form online.

1. Click ‘Get Form’ button to obtain the form and open it in a convenient editor.
2. Complete Part I: As the employee, fill in your name, EMPLID, title, department, work and home telephone numbers, the name of the family member requiring care, their relationship to you, and their age if they are a son or daughter. Additionally, state the care you will provide.
3. Sign and date Part I to confirm that you understand the Medical Leaves for Staff policy and agree to the leave provisions.
4. Part II must be completed by the health care provider. Ensure that they fill out their name, type of practice, and contact information.
5. The health care provider will answer questions about the medical facts regarding the family member's condition, including the approximate date the condition started and expected duration.
6. The provider will detail the amount of leave needed for the patient and any follow-up treatments or visits, confirming the frequency and nature of the care required.
7. Ensure the health care provider explains the care necessary for the patient and why it is medically required, including any episodic flare-ups that may occur.
8. Both you and the health care provider need to sign the completed form, and the provider must date it.
9. Review the completed form for accuracy, then save changes, download, print, or share the file as needed.

Begin filling out your Cornell University Family Leave Provider Verification Form online today.