Medical Certificate to Support Entitlement to Family Caregiver Leave, Family Medical Leave, and/or Critical Illness Leave 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name and the date of examination in the designated fields.
3. For Family Caregiver Leave, check 'Yes' or 'No' for whether the patient has a serious medical condition. If applicable, provide the earlier date of this condition.
4. For Family Medical Leave, confirm if the patient has a serious medical condition with a significant risk of death within 26 weeks. Again, provide earlier dates if necessary.
5. In the Critical Illness Leave section, fill in the patient's date of birth and answer questions regarding their health status and need for family support.
6. Complete the signature section with the health practitioner's details and ensure all required fields are filled out accurately before submitting.

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