FMLA Medical Certification Form for Employees
Used to obtain physician certification that the employee needs time off for a serious health condition
Employers covered by the FMLA 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 treat a serious health condition.
The revised U.S. Department of Labor FMLA regulations, effective January 16th, include 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 the employee's family member. Please see item # EZ-426 for that version of the form).