Virginia FMLA Certification of Physician

State:
Multi-State
Control #:
US-AHI-202
Format:
Word; 
Rich Text
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

Virginia employees may take up to 12 weeks of leave in a 12-month period for a serious health condition, bonding with a new child, or qualifying exigencies. This leave renews every 12 months, as long as the employee continues to meet the eligibility requirements set out above.

Employee's serious health condition, form WH-380-E use when a leave request is due to the medical condition of the employee. Family member's serious health condition, form WH-380-F use when a leave request is due to the medical condition of the employee's family member.

Since the FMLA was revised in 2009, the certifications in support of leave for a serious health condition may include a diagnosis. This can help employers, but employers shouldn't rely solely on a diagnosis. This is, in part, because employers generally cannot require that a certification include a diagnosis.

WH-380-E (Certification of Health Care Provider for Employee's Serious Health Condition)

In short, a medical certification is a relatively short form that is filled out by a health care provider and provided to the employer to establish a patient or family member's medical condition that requires FMLA-protected leave.

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.

Among the forms changed were the WH-381, the notice of eligibility and rights and responsibilities; WH-382, designation notice; WH-380-E, medical certification of an employee's serious health condition; and WH-380-F, medical certification of a family member's serious health condition.

A medical certificate or doctor's certificate is a written statement from a physician or another medically qualified health care provider which attests to the result of a medical examination of a patient. It can serve as a sick note (documentation that an employee is unfit for work) or evidence of a health condition.

How do I write a medical certificate?be legible.include your name and your practice address.clearly state the name of the patient.avoid medical jargon.specify the date when the examination took place and the date the certificate was issued.identify the matter you are certifying and the applicable time period.

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Virginia FMLA Certification of Physician