BHEALTHb CARE PROVIDER CERTIFICATION For Employee39s bb - oregon 2025

1. Click ‘Get Form’ to open the BHEALTHb CARE PROVIDER CERTIFICATION in the editor.
2. In Section I, enter the employee’s name, work location, and optional personal email and contact number. This information is crucial for identifying the employee requesting leave.
3. Proceed to Section II where the health care provider must complete all fields. Start by marking all applicable conditions that pertain to the patient. Ensure you provide detailed medical facts supporting these selections.
4. Fill in the approximate date when the condition began and estimate the current dates of incapacity or absence from work. This helps establish a timeline for leave entitlement.
5. Indicate if this is related to a chronic condition or pregnancy, and if so, specify whether the patient is currently incapacitated along with expected duration and frequency of incapacity.
6. Complete questions regarding treatment needs, including any required follow-up appointments or prescriptions. Provide details on treatment intervals if applicable.
7. Finally, ensure that the health care provider signs and dates the form before returning it to the patient or faxing it to the Oregon Department of Corrections.

Start using our platform today for free to streamline your document editing and form completion!