For California Family Rights Act (CFRA) or Family and Medical Leave Act (FMLA) 2025

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The document is a certification form for health care providers related to the California Family Rights Act (CFRA) and the Family and Medical Leave Act (FMLA). It outlines the requirements for certifying a serious health condition, including definitions, necessary information about the employee and patient, and guidelines on genetic information disclosure. The form includes questions regarding the patient's medical condition, treatment duration, and whether the employee needs leave for their own health issues or to care for a family member.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the Employee Name in the designated field. If the patient is not the employee, provide their name and relationship.
Indicate the date when the medical condition or need for treatment commenced. Remember, do not disclose any underlying diagnosis without consent.
Fill in the probable duration of the medical condition or treatment needed.
Review the description of a 'serious health condition' and answer whether the patient's condition qualifies as such.
If applicable, answer questions regarding the employee's ability to perform work and essential functions.
For family member care, indicate if assistance is required for basic needs and whether employee participation is warranted.
Estimate how long care will be needed or when employee presence would be beneficial.
If requesting intermittent leave, specify frequency and duration of leave needed for appointments or treatments.
Complete item 10 by stating what care will be provided and estimate time periods for intermittent leave if necessary.

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Who is eligible for FMLA CFRA?

What are the FMLA and CFRA laws? Take medical leave for yourself. Care for a family member who is seriously ill. Bond with a new child. Participate in a qualifying event because of a family members military deployment to a foreign country.

What conditions qualify for FMLA leave California?

Because of a new law called SB 951, starting on January 1, 2025, people on leave from work who apply for Paid Family Leave or State Disability Insurance will receive 70-90% of their regular income, (up from 60-70%), for claims starting in 2025.

What are the requirements for FMLA in California?

In order to be eligible to take leave under the FMLA, an employee must (1) work for a covered employer, (2) work 1,250 hours during the 12 months prior to the start of leave, (3) work at a location where 50 or more employees work at that location or within 75 miles of it, and (4) have worked for the employer for 12

What medical conditions qualify for FMLA?

FMLA - Serious Health Condition Alzheimers disease; chronic back conditions; cancer; diabetes; nervous disorders; severe depression; pregnancy or its complications, including severe morning sickness and prenatal care; treatment for substance abuse, multiple sclerosis;

What is the difference between CFRA and FMLA in California?

The FMLA and CFRA have different requirements for employer coverage. The FMLA covers employers with 50 or more employees within a 75-mile radius. CFRA, however, applies to employers with five or more employees, making it accessible to those working for smaller companies in California.