FAMILY AND MEDICAL LEAVE ACT (FMLA) CERTIFICATION FORM 2025

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If an employee does not provide either a complete and sufficient certification or an authorization allowing the health care provider to provide a complete and sufficient certification to the employer, the employees request for FMLA leave may be denied.
Because of doctors workloads and the inability in many situations to render a precise prognosis about the frequency and duration of a condition, it can be a challenge when they have to complete patients FMLA request forms.
Theres nothing for you to fill out yourself, but if your employer uses this form to ask for additional information to determine whether your leave request is valid, youll need to take steps to provide that information.
Yes. Doctors can and usually do charge a fee to complete Family and Medical Leave Act (FMLA) certifications. Under federal law, employers are not required to pay for fees charged for FMLA certification (other than for a second or third opinion), so the employee must take on that responsibility.
ing to the U.S. Department of Labors FMLA Guide for Employers, Authentication means providing the health care provider with a copy of the certification and confirming that the information contained on the certification form was completed and/or authorized by the health care provider who signed the document.
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