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

1. Click ‘Get Form’ to open it in the editor.
2. 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.
3. 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.
4. 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.
5. Once completed by your provider, review the form for accuracy before submitting it to The Hartford via mail or fax as indicated.

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