Get Dc Pfl-mmc 2020-2025

The DC PFL-MMC form is essential for individuals seeking Medical Leave benefits under the District of Columbia's Paid Family Leave law. This guide will provide a step-by-step approach to completing the form online, ensuring that you understand each section and its requirements.

Follow the steps to complete the DC PFL-MMC form online.

1. Click 'Get Form' button to access the DC PFL-MMC. This will open the form in your online editor.
2. In Section 1, complete the details required from the claimant. Fill in your last name, first name, date of birth, middle name, and social security number or individual tax identification number (ITIN). Ensure all information is accurate and complete.
3. Proceed to Section 2, where your licensed health care provider will need to complete the required fields. They will provide their first name, last name, mailing address, telephone number, email address, type of practice or medical specialty, state license number, and optional national provider identifier.
4. In the subsection B, your health care provider will detail the claimant’s medical condition. This includes naming the diagnosis and providing the primary ICD-10 code. They may also indicate a secondary ICD-10 code if necessary.
5. Your health care provider will respond to a series of yes/no questions regarding the patient's medical condition. They will provide relevant dates for diagnosis, expected recovery, and any required inpatient care.
6. Ensure that your health care provider adds any additional information about the diagnosis or condition, if necessary, for clarity.
7. Once completed, your health care provider must sign the form and indicate the date when the certification was completed.
8. After both sections of the form are filled out and signed, save your changes. You will then be able to download, print, or share the completed DC PFL-MMC form as needed for your filing process.

Complete your DC PFL-MMC form online for a smoother application process and to ensure that you receive the benefits you deserve.