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 FML Certification Form Care of a Family Member 01 12 DOC 2012-2023

FML Certification Form Care of a Family Member 01 12 DOC 2012-2023

Use a fmla forms for family member 2012 template to make your document workflow more streamlined.

This certification is needed for you to get or keep the benefit of FMLA protections. Family Medical Leave Act FMLA Certification for Family Member s Serious Health Condition1 Return completed form to Aetna Life Insurance Company PO Box 14560 Lexington KY 40512-4560 Fax 866-667-1987 SECTION I For Completion by the EMPLOYEE INSTRUCTIONS to the EMPLOYEE Please complete Section I before giving this form to your family member s health care provider to fill out. If the treating provider is a...
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