Hawaii FMLA Certification of Physician

State:
Multi-State
Control #:
US-AHI-202
Format:
Word
Instant download

Description

This AHI form is used by employers who have an employee that has requested medical leave. This form is filled out by the physician of the person that is being treated.
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FAQ

According to the Equal Employment Opportunity Commission which enforces the ADA employers can have a policy requiring all employees provide doctor's notes to substantiate a disability, request reasonable accommodations or prove the need for leave.

Under the Hawaii Family Leave Law and rules, an employee may be eligible for up to four (4) weeks of unpaid family leave each calendar year for the birth or adoption of a child, or to care for his / her child, spouse, reciprocal beneficiary, or parent with a serious health condition.

To apply for FMLA, the employee must take an FMLA Medical Certification Form to their health care provider. This form ensures that the employee's or family member's applicable health condition is valid. After receiving the form, the employee must return it within 15 calendar days.

Fill out Section 2 of the form. If you are completing form WH-380-F, you will be required to provide information about the family member you are caring for during FMLA leave; such as their full name, your relationship to one another, and a description of your methods for providing care for that person.

EligibilityHave worked for your employer for at least 12 months; and.Have worked for your employer for at least 1,250 hours in the 12 months before you are taking leave; and.Work at a location where your employer has at least 50 employees within 75 miles of your worksite.

How to File a Paid Family Leave (PFL) Claim by MailVisit Online Forms and Publications and order a form online. A form will be mailed to you.Obtain the form from your physician/practitioner or employer.Visit an SDI Office.Call 1-877-238-4373. California Relay Service (711) Provide the PFL number (1-877-238-4373)16-Feb-2022

No. An employer cannot require a physician's note every time an employee misses work while taking FMLA intermittent leave. The term physician's note is not referenced in the FMLA; recertification, however, is.

Doctors aren't the only health care providers who may certify FMLA leave. Podiatrists, dentists, clinical psychologists, optometrists and chiropractors can all certify leave, as can nurse practitioners, nurse-midwives, clinical social workers and physician assistants.

Eligibility Under the FMLAAll types of employees are eligible.The employee must have worked for the State of Hawai'i for at least 12 months (need not be consecutive), and.The employee must have worked at least 1,250 hours over the 12-month period immediately preceding the employee's leave.

You do not have to tell your employer your diagnosis, but you do need to provide information indicating that your leave is due to an FMLA-protected condition (for example, stating that you have been to the doctor and have been given antibiotics and told to stay home for four days).

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Hawaii FMLA Certification of Physician