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Certification of Health Care Provider for Family Member's Serious Health Condition (FMLA) Form 2678

Certification of Health Care Provider for Family Member's Serious Health Condition (FMLA) Form 2678-2025

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34 votes

The document is a certification form for the Family and Medical Leave Act (FMLA) provided by the New York City Health and Hospitals Corporation. It outlines the process for an employee to request leave to care for a family member with a serious health condition. The form includes sections for completion by an HHC representative, the employee, and the healthcare provider, detailing necessary information about the employee's job, the family member's condition, and the required care.

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2017	4.6 Satisfied (34 Votes)

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How do I apply for FMLA in Illinois?

To apply for FMLA, the employee must take an FMLA Medical Certification Form to their health care provider. This form ensures that the employees or family members applicable health condition is valid. After receiving the form, the employee must return it within 15 calendar days.

Can an employer deny FMLA in Florida?

If the employer has fewer than 50 employees, if you have been employed under a year, or have worked fewer than 1,250 hours in the prior 12 months, you can be denied FMLA leave. But theres a lot more to know about the Family Medical Leave Act, what the rules are and how to make sure your request is approved.

How to apply for FMLA in Florida?

Applying for FMLA The employees health care provider must complete a certification form that validates the employees serious health condition or that of an immediate family member. The employee must provide this certification to the employer within 15 calendar days of receiving it.

What is the difference between WH 380 E and WH 380 F?

Employees serious health condition, form WH-380-E use when a leave request is due to the medical condition of the employee. Family members serious health condition, form WH-380-F use when a leave request is due to the medical condition of the employees family member.

Can I get paid for FMLA in Florida?

Unpaid, unless you have accrued leave credits (regardless of whether you qualify for short-term disability or Workers Compensation benefits). As long as you return to work at or before the end of the allowed leave, you will return to your former position or one that is equivalent in terms of benefits, pay and status.

What qualifies for FMLA in Florida?

Employees are eligible for leave if they have worked for their employer at least 12 months, at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles.

What are qualifying reasons for FMLA?

Under the regulations, a mother can use 12 weeks of FMLA leave for the birth of a child, for prenatal care and incapacity related to pregnancy, and for her own serious health condition following the birth of a child.

Certification of Health Care Provider for Family Member's Serious Health Condition (FMLA) Form 2678-2025

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