MEDICAL LEAVE MEDICAL CERTIFICATION FORM (PFL-MMC) 2026

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The document is a Medical Leave Medical Certification Form (PFL-MMC) used to apply for Medical Leave benefits under the DC Paid Family Leave law. It requires claimants to provide personal information and have their licensed health care provider complete sections regarding the patient's serious health condition, including diagnosis, treatment, and expected recovery dates. The form must be submitted through the online benefits portal after being signed by the health care provider.

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Click ‘Get Form’ to open the MEDICAL LEAVE MEDICAL CERTIFICATION FORM (PFL-MMC) in the editor.
In Section 1, enter your last name, first name, middle name, date of birth, and Social Security Number or ITIN. Ensure all fields are accurately filled out for proper identification.
Proceed to Section 2, which must be completed by your licensed health care provider. They will provide necessary details about your medical condition and treatment.
Your health care provider should answer the yes-or-no questions regarding your condition and provide relevant dates where applicable. This information is crucial for determining eligibility for benefits.
Once both sections are completed and signed, save the document. You can easily upload it through the online Paid Family Leave benefits portal as part of your filing process.

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Versions	Form popularity	Fillable & printable
2022	4.9 Satisfied (59 Votes)
2020	4.9 Satisfied (58 Votes)
2020	4.7 Satisfied (25 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How much does Washington Medical Leave pay?

When employees use their paid sick leave, contractors must provide workers with their regular pay and benefits. When eligible employees use their paid sick time, employers are required to pay workers their usual rate of pay. FMLA leave is unpaid leave.

What condition requires a medical leave?

The benefit amount an employee can receive depends on how much money they make weekly compared to others in Washington. After a 7-day waiting period (if applicable) employees are eligible for up to $1,542 maximum per week in 2025.

How do you take a medical leave of absence?

To take FMLA leave, you must provide your employer with appropriate notice. If you know in advance that you will need FMLA leave, you must give your employer at least 30 days advance notice. If you know you need leave less than 30 days in advance, you must give your employer notice as soon as you can.

Who can fill out medical leave paperwork?

Most FMLA leave forms require you to fill out a section on your own, with your medical provider and employer filling out the rest.

How do you qualify for medical leave in Washington state?

An FMLA serious health condition generally involves a period of incapacity. Incapacity means an individual is unable to work, attend school, or perform other regular daily activities because of the serious health condition, due to treatment of it, or for recovery from the condition.

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What qualifies for medical leave in Washington?

Up to 12 weeks of medical leave or family leave. Medical leave is for recovering from or getting treatment for a serious health condition. Family leave is for taking care of a qualifying family member who has a serious health condition, for bonding with a new child or for certain military events.