Non fmla medical certification form 2026

1. Click ‘Get Form’ to open the non-FMLA medical certification form in our editor.
2. Begin by entering the employee’s name and the SPHS facility in the designated fields at the top of the form.
3. Next, provide the patient’s name if it differs from the employee's. This is crucial for accurate documentation.
4. Select the applicable category for serious health conditions by checking one of the options provided. This helps clarify the nature of the medical issue.
5. In the section labeled 'Describe the medical facts which support your certification,' provide a detailed diagnosis to substantiate your request.
6. Fill in additional details regarding treatment dates, frequency, and any necessary supervision required for ongoing care.
7. Finally, ensure that both you and your physician sign and date the form before submission to validate its authenticity.

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