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- Click ‘Get Form’ to open the Hartford form in the editor.
- Begin by completing Section I, which requires your personal information such as your name, leave ID, and date of birth. Ensure you sign page 3 before handing it over to your health care provider.
- Instruct your health care provider to fill out Section II. They will need to provide detailed medical information regarding your condition, including treatment dates and any necessary follow-up appointments.
- Once completed, ensure that your provider returns the form to you. You must submit it to The Hartford within 15 days of requesting leave.
- Finally, review all sections for accuracy before sending the form via mail or fax as specified in the instructions.
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