Family39s bSerious Healthb Condition Certification of bHealthb bb - SLCo 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with SECTION I, where the agency must complete their contact information. Ensure this section is filled out accurately as it is crucial for confidentiality.
3. Move to SECTION II, where you will provide your personal details. Fill in your name and the name of the family member you are caring for, including their relationship to you and date of birth if applicable.
4. Describe the care you will provide and estimate the leave needed. This information helps clarify your situation and needs.
5. In SECTION III, ensure that your health care provider completes their part accurately. They will need to provide medical facts about the condition and any necessary follow-up treatments.
6. Review all sections for completeness before submitting the form to ensure a smooth process.

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