OB/GYN FMLA form information - Mercy 2025

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Yes. Doctors can and usually do charge a fee to complete Family and Medical Leave Act (FMLA) certifications. Under federal law, employers are not required to pay for fees charged for FMLA certification (other than for a second or third opinion), so the employee must take on that responsibility.
Because of doctors workloads and the inability in many situations to render a precise prognosis about the frequency and duration of a condition, it can be a challenge when they have to complete patients FMLA request forms.
If you are completing form WH-380-F, you will be required to provide information about the family member you are caring for during FMLA leave; such as their full name, your relationship to one another, and a description of your methods for providing care for that person.
When employees need to take sick leave due to illness, they may need to provide their employer with a doctors note in California. Your medical details are protected by FMLA and HIPAA laws, and employers cannot request information about their medical conditions or obtain copies of their medical records.
The FMLA does not require the use of any specific certification form. The Department has developed optional forms that can be used for leave for an employees own serious health condition (WH-380-E) or to care for a family members serious health condition (WH-380-F).
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This form has two sections, one that your employer will complete, and one for your doctor or health care provider to complete. Your human resource office will usually give you the partially-completed form for your healthcare provider to complete.
Youll need to provide your family members name and your relationship to that family member (only certain relatives qualify). Youll also need to describe the type of care you must provide and how much time off you will need.

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