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How to use or fill out FAMILY AND MEDICAL LEAVE ACT (FMLA) CERTIFICATION FORM with our platform
- Click ‘Get Form’ to open the FAMILY AND MEDICAL LEAVE ACT (FMLA) CERTIFICATION FORM in the editor.
- Begin by filling out the Employee’s Section. Enter your name, Banner ID, and department. If you are not the patient, provide the patient's name.
- Sign the Medical Release section to authorize the release of necessary medical information. Ensure you date your signature accurately.
- Indicate the reason for FMLA leave by checking the appropriate box related to your medical condition or that of a family member.
- In the Provider’s Section, ensure all medical details are filled out completely. This includes dates of treatment and any relevant medical facts supporting your request.
- Have your healthcare provider sign and date their section, including their contact information and tax ID number.
- If applicable, complete the Birth/Placement of a child section with required documentation dates.
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