Get Certification Of Healthcare Provider For ... - Florida Atlantic University - Fau

Filling out the Certification Of Healthcare Provider form is an essential step for employees seeking extended medical leave or Family Medical Leave Act protections at Florida Atlantic University. This guide will help you navigate the process with clear, step-by-step instructions to complete the form accurately.

Follow the steps to complete the Certification Of Healthcare Provider form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section I, provide your personal information, including your name, department, job title, supervisor's name and phone number, regular work schedule, and essential job functions. Indicate if you have previous employment with FAU and the relevant dates.
3. Once Section I is complete, give the form to your healthcare provider for Section II to be filled out. Ensure your provider answers all applicable questions with detailed and accurate information.
4. In Part A of Section II, your healthcare provider will provide medical facts about your condition, including the approximate onset date and the duration of your condition. They will also need to confirm if hospitalization was required and if treatment visits will be necessary frequently.
5. In Part B, your healthcare provider will detail the amount of leave needed, including any planned follow-up treatment and recovery time. The provider should estimate the schedule for medical appointments as well as the expected impact of your condition on your work capacity.
6. Be sure all sections are signed by the healthcare provider and ensure that any additional information is clearly marked and completed.
7. Once the form is complete, you may either return it to your healthcare provider for submission or send it directly to FAU's Human Resources Department at the specified address or via the confidential fax number provided.
8. Finally, review the completed form for accuracy, save any changes, and choose to download, print, or share the form as needed.

Complete your Certification Of Healthcare Provider form online for a smoother process in securing your medical leave.