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E s Name: Patient s Name: (Please check one) Relationship to patient: self spouse parent child (age ) domestic partner parent-in-law grandparent grandchild parent of domestic partner child of a domestic partner (age ) Section II: Health Care Provider Completes this Section Please complete all sections in order for the agency to.
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Pdf FAQ
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If you have questions, or you think that your rights under the FMLA may have been violated, you can contact WHD at 1-866-487-9243. You will be directed to the WHD office nearest you for assistance.
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Telephone: (877)499-8606. Fax: (888)485-0973.
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Employee must have worked for at least 1250 hours during the 12-month period immediately preceding the leave. condition requiring home care), in addition to the 180-day requirement above, the employee must have worked an average of 25 hours per week. Both of the above requirements apply to all types of FMLA leave.
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Complete application for FMLA/OFLA Leave. 2. Have your medical provider complete the Medical Certification Form if required. The certification can be faxed directly to HR (541) 325-0435 from the medical provider's office, or the employee may provide it directly to HR.
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All Oregon workers get sick time, but those who work for larger employers can qualify for protected leave under OFLA or the federal Family and Medical Leave Act (FMLA). OFLA leave gives you job protection, but OFLA is unpaid unless you have vacation, sick, or other paid leave.
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