How to use or fill out calhr 754 with our platform
- Click ‘Get Form’ to open the calhr 754 in the editor.
- In Part A, enter the employee's last name, first name, middle name, last day worked, classification, work unit, and department contact details. Ensure you attach a copy of the employee's job description.
- Move to Part B where the employee must provide their regular work schedule and daytime contact number. They should also indicate if they are full-time or part-time and specify any unique work arrangements.
- In Part C, the health care provider will need to complete their section. They should provide their name, business address, and medical specialty. It's crucial that they answer all questions regarding the patient's condition accurately.
- Part D requires detailed medical facts about the employee’s condition. The health care provider must confirm if it qualifies as a serious health condition and provide specifics on treatment duration and frequency.
- Finally, in Part E, estimate the amount of time needed for leave due to incapacity. This includes continuous periods of time and any follow-up appointments required.
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