HEALTH CARE PROVIDER CERTIFICATION ... - State of Oregon - oregon 2026

1. Click ‘Get Form’ to open the HEALTH CARE PROVIDER CERTIFICATION in the editor.
2. In Section I, the employee should fill in their name and the patient's name. Select the appropriate relationship to the patient from the provided options.
3. Move to Section II, where the health care provider must complete all sections. Begin by marking all applicable conditions that pertain to the patient.
4. Provide a detailed description of medical facts supporting the certification in the designated area.
5. Indicate the approximate date when this condition began and estimate how long the patient's incapacity is expected to last.
6. Answer questions regarding chronic conditions, treatment regimens, and whether intermittent leave will be necessary for the employee due to the patient's condition.
7. Finally, ensure that both signature and printed name of the health care provider are included along with their field of practice and address before submitting.

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