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Get DC PFL-MMC 2022-2024

Whether you have a serious health condition as defined by the DC Paid Family Leave law. You must complete part 1 of the form. Your doctor or licensed health care provider must complete part 2 of the form. You may complete the filing process for Medical Leave benefits only after this form is completed and signed by your doctor. Please ensure that your health care provider completes all sections of part 2 of the form or your claim may be denied. You must scan and upload this form to the onl.

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