Get Health Care Provider For A Covered Servicemember Certification

Filling out the Health Care Provider For A Covered Servicemember Certification is an essential step in requesting leave under the Family Medical Leave Act (FMLA) for the care of a covered servicemember. This guide provides a clear and supportive walkthrough of the form's components to ensure users can complete it accurately and efficiently.

Follow the steps to complete the certification form online.

1. Click 'Get Form' button to obtain the form and open it in the online editor.
2. Begin with Section I, which must be completed by the employee or covered servicemember requesting leave. Fill in your name, employee ID number, and the name of the covered servicemember you will be caring for.
3. Specify your relationship to the covered servicemember by selecting from the provided options, such as son, daughter, spouse, parent, next of kin, or registered domestic partner.
4. In Part B, indicate whether the covered servicemember is currently serving in the Armed Forces, National Guard, or Reserves. If yes, provide their military branch, rank, and unit.
5. Answer the questions regarding whether the servicemember is on the Temporary Disability Retired List and if they are assigned to a military medical treatment facility as an outpatient.
6. In Part C, describe the care required for the covered servicemember and provide an estimate of the duration of leave needed to provide this care.
7. Proceed to Section II, which must be completed by an authorized health care provider. They will fill in their information, including type of practice, contact details, and business address.
8. The health care provider will classify the covered servicemember’s medical condition and answer the questions regarding treatment and duration. Ensure all fields are completed accurately.
9. Make sure the health care provider signs and dates the form upon completion.
10. Finally, review the completed certification form for any errors or missing information before saving changes, downloading, printing, or sharing it online.

Take the first step by filling out your documents online today.