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The Family and Medical Leave Act (FMLA) - SIUE

The Family and Medical Leave Act (FMLA) - SIUE 2026

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The document is a medical certification form for employees requesting leave under the Family and Medical Leave Act (FMLA) to care for a family member. It includes sections for employee information, medical facts from a healthcare provider, and details about the amount of leave needed. The form requires signatures from both the employee and the healthcare provider, ensuring compliance with regulations such as the Genetic Information Nondiscrimination Act (GINA).

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Click ‘Get Form’ to open it in the editor.
Begin with SECTION I, where you will provide your employee information. Fill in your Banner ID, name, and details about the family member requiring care, including their relationship to you and date of birth if applicable.
Describe the care you will provide and estimate the leave needed. Ensure to sign and date this section before passing it to your family member or their medical provider.
In SECTION II, the health care provider will complete PART A by providing medical facts such as diagnosis, treatment dates, and any prescribed medications. Make sure they answer all relevant questions regarding the patient's condition.
PART B requires the health care provider to specify the amount of leave needed. They should detail any periods of incapacity, follow-up treatments, and whether care is needed on an intermittent basis.

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Can an employer ask why you are using FMLA?

Under the Family and Medical Leave Act (FMLA), an employer cannot ask for detailed personal information regarding the reason for taking leave. However, they can ask for basic information to determine if the leave qualifies under FMLA.

What excuses can you use FMLA for?

(Q) Is my employer required to pay me when I take FMLA leave? The FMLA only requires unpaid leave. However, the law permits an employee to elect, or the employer to require the employee, to use accrued paid vacation leave, paid sick or family leave for some or all of the FMLA leave period.

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 conditions qualify for FMLA leave in Illinois?

Leave under FMLA You are entitled to leave under the FMLA only: If you or an immediate family member (spouse, child, or parent) have a serious health condition, For birth and care of a newborn child, or. For placement of a child with you for adoption or foster care.

What are the reasons to take off for FMLA?

Eligible employees can take FMLA leave to care for a child, spouse, or parent who has a serious health condition. Caring for a family member under the FMLA includes assistance with basic medical, hygienic, nutritional, safety, transportation needs, physical care, or psychological comfort.

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What to say to get FMLA approved?

I let them know that I have a chronic medical condition that warrants me taking time off to deal with it. Whether it be intermittently or full time for a period of time. If they want to know details all they need to do is read the Certification that my doctor fills out explaining that I need the time off.

Does anxiety qualify for FMLA leave?

For Self: An employee can take FMLA time if they have a serious health condition that severely impacts their ability to work. Some common conditions that may qualify include depression and severe anxiety. For Family Members: An employee can take FMLA leave to provide care for their spouse, parent, or child.

The Family and Medical Leave Act (FMLA) - SIUE 2026

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