Get Neola 4430.01 F4 2006-2025

Filling out the NEOLA 4430.01 F4 form is an essential process for employees seeking reinstatement after taking Family and Medical Leave Act (FMLA) leave. This guide provides clear, step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete the NEOLA 4430.01 F4 form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by entering the employee's name in the designated field. This should be the full name of the person who took FMLA leave.
3. Next, fill in the position of the employee. Specify the job title currently held.
4. In the building field, provide the name of the location where the employee works.
5. Describe the employee's serious health condition that led to their taking FMLA leave. Include as much detail as necessary to explain the situation.
6. Enter the date when the FMLA leave began. This should be the starting date of the leave.
7. Specify the date when the FMLA leave is expected to end. This is important for determining the duration of the leave.
8. Fill in the name of the treating health care provider. This should be the individual responsible for the employee's care.
9. Indicate the field of specialization for the medical practice, if applicable.
10. Select 'Yes' or 'No' to indicate whether the employee is able to perform the essential functions of their job, with or without a reasonable accommodation.
11. If any restrictions or accommodations are necessary for the employee to return to work, detail them in the provided space.
12. The health care provider must sign the form in the designated area, confirming their endorsement.
13. Lastly, record the date on which the health care provider signed the form.
14. Ensure that the Health Care Provider Authorization for Release of Information is completed as required, using Form 4430.01 F5 or a similar HIPAA-compliant form.
15. Once all fields are complete, save your changes, download a copy, print the form, or share it as needed.

Complete your NEOLA documents online today to ensure a smooth process for FMLA leave reinstatement.