Get Cornell University Personal Medical Leave Provider Verification Form 2021-2025

Completing the Cornell University Personal Medical Leave Provider Verification Form is an essential step for ensuring your medical leave is appropriately documented. This guide provides you with clear instructions on how to fill out the form online, making the process straightforward and efficient.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to access the verification form and open it in your preferred editing tool.
2. Begin with Part I of the form, where you, the employee, should enter your name, employee ID (EMPLID), title, department, work and home telephone numbers, and essential job functions.
3. Sign and date Part I to confirm you have read, understood, and agree to the Medical Leaves for Staff policy.
4. Instruct your health care provider to complete Part II of the form. They need to provide the patient’s name, approximate date the condition commenced, probable duration of the condition, and pertinent medical facts.
5. The health care provider will need to mark applicable boxes regarding treatment, hospital admission, prescribed medication, and necessary medical evaluations.
6. In Part B, the health care provider should indicate the amount of leave needed, including whether the patient will be incapacitated for a single continuous period, and provide an estimation of treatment schedules or reduced work hours as necessary.
7. Once Part II is completed, ensure both forms (Part I and Part II) are signed and returned to Human Resources within 15 days of receiving the eligibility letter.
8. Finally, after completing all sections, save your changes, download, print, or share the form as needed.

Start filling out the Cornell University Personal Medical Leave Provider Verification Form online today to ensure your medical leave is properly documented.