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