Get Dc Pfl-mmc 2020-2025

Filling out the DC PFL-MMC form correctly is essential for obtaining medical leave benefits. This guide provides clear, step-by-step instructions to ensure that you complete the form accurately and efficiently.

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

1. Press the ‘Get Form’ button to access the DC PFL-MMC online and open it in the editing interface.
2. Begin with Section 1, where you, the claimant, need to fill in your last name, first name, date of birth (MM/DD/YYYY), middle name, and Social Security Number or Individual Tax Identification Number (ITIN). Ensure all information is entered accurately.
3. Move to Section 2, which is designated for completion by your licensed health care provider. Make sure your provider fills out Parts A, B, and C. This is crucial for determining your eligibility for medical leave benefits.
4. In Part A, your health care provider will provide their first name, last name, mailing address, telephone number, middle name, city, state, email address, type of practice or medical specialty, and state license number. Optional fields include the National Provider Identifier.
5. In Part B, the provider must describe the qualifying medical condition by stating the diagnosis or symptoms, entering the primary ICD-10 code, and, if applicable, the secondary ICD-10 code. They will also provide the date the health condition was diagnosed and check applicable statements associated with the patient's condition.
6. Part C requires the health care provider to outline the amount of leave needed, including details like the start and end dates of continuous incapacity, planned medical appointments, and any expected unpredictable episodes or flare-ups.
7. Once all sections are filled out, the health care provider must sign and date the form, certifying that the information is true and complete.
8. After completion, save changes to the form. You may also download, print, or share the form as required for your filing process.

Complete your DC PFL-MMC form online today for a smooth filing experience.