Home
Forms Library
LC-7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12-16-08 forms

LC-7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12-16-08 forms-2026

LC-7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12-16-08 forms Preview on Page 1

See details

4.3 out of 5

116 votes

The document is a Certification of Health Care Provider form for employees requesting leave under the Family and Medical Leave Act (FMLA) due to a serious health condition. It outlines the responsibilities of both the employee and the health care provider in completing the form, including providing medical information and estimated leave duration. The document emphasizes compliance with the Genetic Information Nondiscrimination Act (GINA) and includes sections for medical facts and amount of leave needed.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out LC-7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12-16-08 forms with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open it in the editor.
Begin with Section I, where you will complete your personal information including your name, Social Security number, and job title. Ensure all fields are filled accurately.
Sign page 3 of the form and provide it to your health care provider for completion. Make sure they understand the importance of returning the completed form to you within the specified timeframe.
Instruct your health care provider to fill out Section II, which includes medical facts about your condition. They should provide detailed answers regarding treatment and any limitations on your job functions.
Once completed by your provider, review the form for accuracy before submitting it to The Hartford via mail or fax as indicated.

Start using our platform today for free to streamline your document editing and ensure a smooth submission process!

See more LC-7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12-16-08 forms versions

We've got more versions of the LC-7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12-16-08 forms form. Select the right LC-7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12-16-08 forms version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (140 Votes)
2015	4.3 Satisfied (116 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What health conditions are covered under FMLA?

FMLA - Serious Health Condition Serious health condition means an illness, injury, impairment, or physical or mental condition which requires: Overnight hospitalization (including prenatal care), including the period of incapacity or subsequent treatment in connection with the overnight care.

What is a completed certification for FMLA?

The medical certification is a short form completed by a health care provider. Its provided to the employer to establish the workers or family members medical condition that qualifies for FMLA-protected leave. The FMLA doesnt require a specific certification form.

Can I approve FMLA without certification?

Simply put, you do not need medical certification in your hand to designate leave. As the regulations state, if you have enough facts based on the employees notice to establish that the employee requires leave that is covered by the FMLA, you can designate it as such. No other questions asked or information needed.

What is the effective date of certification?

Effective Date of Certification . means the date on which Procurement Commission staff has determined to be the effective date of any approved certification of goods or services.

What is a serious health condition under MA PFML?

CERTIFYING A SERIOUS HEALTH CONDITION. The FMLA defines a serious health condition as an illness, injury, impairment, or physical or mental condition that involves either inpatient care or continuing treatment by a health care provider. An FMLA serious health condition generally involves a period of incapacity.

Security and compliance

At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.

Learn more

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

Does Hartford pay you for FMLA?

We currently offer fully insured and/or self-insured coverage in: California Voluntary Paid Family Leave (CA VPFL) and California Voluntary Plan Disability Insurance (CA VPDI) Colorado Family and Medical Leave Insurance (FAMLI) Connecticut Paid Family and Medical Leave (PFML)

What is the list date certification requested?

Clarifying the List Date Certification Requested Meaning in FMLA Documentation. When handling FMLA leave requests, employers often encounter the term list date certification requested, which refers to the specific date the employer formally asks the employee to provide medical certification.

What is date of certification?

Certification Date means the later of the date on which an order granting certification or authorization of a Proceeding against one or more Non-Settling Defendants is issued by a Court and the time to appeal such certification or authorization has expired without any appeal being taken, or if an appeal is taken the

LC-7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12-16-08 forms-2026

Here's how it works

How to use or fill out LC-7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12-16-08 forms with our platform

See more LC-7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12-16-08 forms versions

Complete this form in 5 minutes or less

Got questions?

What health conditions are covered under FMLA?

What is a completed certification for FMLA?

Can I approve FMLA without certification?

What is the effective date of certification?

What is a serious health condition under MA PFML?

Security and compliance

Complete this form in 5 minutes or less

People also ask

Does Hartford pay you for FMLA?

What is the list date certification requested?

What is date of certification?

Try more PDF tools

LC-7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12-16-08 forms-2026

Here's how it works

How to use or fill out LC-7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12-16-08 forms with our platform

See more LC-7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12-16-08 forms versions

Complete this form in 5 minutes or less

Got questions?

What health conditions are covered under FMLA?

What is a completed certification for FMLA?

Can I approve FMLA without certification?

What is the effective date of certification?

What is a serious health condition under MA PFML?

Related Searches

Security and compliance

Related forms

Complete this form in 5 minutes or less

People also ask

Does Hartford pay you for FMLA?

What is the list date certification requested?

What is date of certification?

Try more PDF tools