Warning! Cookies must be enabled for proper operation of the website.
  • Order by Phone 1-800-333-3795
Welcome guests! | | Register
$0.00 (0 items in your cart)

Shop our products

Enter your email address

FMLA Medical Certification Forms for Family Members

DOL-approved form to verify that employee needs time off to care for ill family member

FMLA Medical Certification Forms for Family Members
Item Type SKU Qty Price
Packs of 25 EZ-426 $15.95

FMLA-covered employers have the right to ask an eligible employee requesting FMLA leave to provide a medical certification from a physician as evidence that the employee needs time off to care for a seriously ill family member.

Recent Department of Labor FMLA regulations included revisions to the standard DOL medical certification form.

To help employers meet their obligations under the FMLA, and to assist them in obtaining certified opinions from medical doctors, Personnel Concepts has made the revised DOL medical certification form available in packs of 25.

(Note: This version of the form applies to employees; the DOL has a separate form available for certifying an employee's serious health condition. Please see item # EZ-425 for that version of the form.)

$15.95 InStock NewCondition

You May Also Need...

FMLA Medical Certification Form for EmployeesFMLA Designation FormsFMLA Notice of Eligibility Forms
FMLA Medical Certification Form for EmployeesFMLA Designation FormsFMLA Notice of Eligibility Forms
$15.95$15.95$15.95
More InfoMore InfoMore Info