Calhr 754 2026

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4.9 out of 5

37 votes

The document is a certification form for health care providers to support an employee's request for leave under the Family and Medical Leave Act (FMLA) and California Family Rights Act (CFRA) due to a serious health condition. It includes sections for departmental administration, employee information, and detailed medical information required from the health care provider. The form outlines the responsibilities of both the employee and the health care provider in providing necessary medical certification, as well as definitions of what constitutes a serious health condition.

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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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Versions	Form popularity	Fillable & printable
2016	4.9 Satisfied (37 Votes)
2013	4.3 Satisfied (280 Votes)

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How does intermittent FMLA work in California?

An employee may take intermittent leave during all or any portion of the 12-month period as long as the total amount of leave does not exceed the 12 or 26 workweeks (under NDAA only) in one 12-month period. Only the actual time taken can be charged against the employees entitlement.

What is the difference between FMLA and CFRA?

The FMLA is a federal law that applies to eligible employees across the United States. In contrast, the CFRA is a California-specific law that mirrors the FMLA but applies only to employees in California.

What are the changes in California FMLA 2023?

On January 1, 2023, two new California laws went into effect, both of which extend employee rights (and, in turn, employer obligations) with respect to employee protected time off under the California Family Rights Act (CFRA)the state law that allows employees to take up to twelve workweeks of unpaid leave for

calhr 754

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What is the new FMLA law in California 2023?

Thus, under the law as of 2023, eligible employees may take CFRA leave for a child, spouse, domestic partner, parent, parent-in-law, grandparent, grandchild, sibling, or someone else related by blood or in a family-like relationship (designated person) with a serious health condition.

What conditions qualify for FMLA leave California?

California law guarantees job-protected leave to eligible employees with a serious health condition, who are caring for a family member with a serious health condition, or to bond with a new child (by birth, adoption, or foster placement).

How long is paid family leave in California 2023?

How long can I receive PFL benefits? You may receive PFL benefits for up to 8 weeks within any 12-month period for care, bonding, or military assist claims. You can break up your eight weeks.

Can I take both FMLA and CFRA?

It is possible that an employee could qualify for 12 weeks of CFRA leave to care for a domestic partner or grandparent (who are not considered eligible family members under the FMLA) and then qualify for 12 weeks of FMLA to care for a child, spouse, or parent, for a total of 24 weeks.

What are the new HR laws in California 2023?

Labor Codes New Rebuttable Presumption of Retaliation The California Labor Code will include a rebuttable presumption of retaliation if an employer takes adverse action against or disciplines an employee within 90 days of that employee engaging in protected conduct.