Medical leave form 2026

1. Click ‘Get Form’ to open the medical leave form in the editor.
2. Begin by filling in your name and employee ID number in Section 1. This information is crucial for identification purposes.
3. Next, enter your supervisor’s name and department to ensure proper routing of the form.
4. In the Healthcare Provider’s Statement, have your healthcare provider certify your ability to return to work by filling in their name and the date you are cleared to return.
5. If there are any restrictions or limitations, select 'Yes' and provide details in the designated area. If there are no restrictions, simply check 'None'.
6. Ensure that your healthcare provider prints their name and phone number, signs the form, and dates it.
7. Once completed, submit the form to your supervisor for their signature before faxing it securely to HR at 615-343-2176. Retain a copy for your records.

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