Get Dc Pfl-mmc 2022-2025

This guide provides clear and supportive instructions on how to complete the DC Paid Family Leave Medical Certification form (PFL-MMC) online. Follow these steps to ensure your application for Medical Leave benefits is filled out accurately and efficiently.

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

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Part 1, provide your personal information. Fill in your last name, first name, middle name, date of birth, and phone number. Ensure all fields are completed accurately to avoid delays.
3. In Part 2, your licensed health care provider needs to complete the information. They must include their name, mailing address, telephone number, email address, type of practice, and state license number. Ensure they provide accurate details.
4. The health care provider should then detail your qualifying medical condition. This includes diagnosing your health condition and providing the primary ICD-10 code. They may also include a secondary code if applicable.
5. The health care provider must check the relevant boxes regarding your medical condition, and provide details as necessary for each checked statement. This includes any pregnancy, incapacity, chronic conditions, or need for restorative treatments.
6. Next, the health care provider will specify the amount of leave needed. They should detail the dates of continuous incapacity, planned medical treatments, or any intermittent incapacity.
7. Finally, your health care provider needs to certify their information by signing and dating the form. Make sure that all parts are completed; otherwise, the form may be returned for further information.
8. Once completed, you can scan the signed document and upload it to the appropriate online portal. Ensure you have finalized all sections before submission.

Complete your DC PFL-MMC form online today to start your application for Medical Leave benefits.