FMLA Certification of Health Condition - University System of Georgia 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your name and relationship to the patient at the top of the form. If you are not the employee, provide the patient's name.
3. In the section regarding care, clearly state what type of care you will provide and estimate the duration. Include a schedule if leave is intermittent.
4. Sign and date where indicated, ensuring that any necessary patient signatures are also obtained for authorization.
5. For healthcare provider sections, ensure they complete all required fields about the patient's condition, including medical facts and treatment plans.
6. Review all entries for accuracy before submitting. Use our platform's features to save or share your completed form as needed.

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