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Get and Sign Fmla Request Form

Get and Sign Fmla Request Form

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Serious health condition. For another reason. (Please specify): Request for Intermittent or Reduced-Schedule Leave I request intermittent leave or reduced-schedule leave at the following times: Schedule: Reason: Substitution of Paid Leave I request to use (check all that apply): Paid Vacation Sick Hours Other Location During Leave I can be reached at the following address and phone number during my leave: Employee Signature Approved By Date © The Personnel...
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Our HR hotline Christi's countless questions throughout the year regarding which medical professionals can fill out FMLA forms for employees which is what we will be discussing in a few moments but first a little background regarding the FMLA process in order to be placed on a Family Medical Leave a hEvalth care provider must complete a certification form in order to ensure the validity of the serious hEvalth condition the FMLA regulations specifically define the term hEvalth care provider as a doctor of medicine or Osteopathy who is authorized to practice medicine or any other person determined by the Secretary of Labor to be capable of providing hEvalth care services the other persons capable of providing hEvalth care services must be authorized to practice in their state and authorized to diagnose and treat physical or mental hEvalth conditions examples include providers such as podiatrists dentists clinical psychologists optometrists chiropractors nurse practitioners midwives clini

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