Calhr form 2013-2026

1. Click ‘Get Form’ to open the calhr form 2013 in the editor.
2. In Part A, enter the employee's last name, first name, middle name, last day worked, classification, work unit, and department contact details. Ensure this section is completed by the leave program administrator.
3. Proceed to Part B where the employee must fill in their regular work schedule and daytime contact phone number. This section is crucial for establishing eligibility for FMLA/CFRA protections.
4. In Part C, provide detailed information as required by the health care provider. They should answer all questions regarding the patient's serious health condition accurately.
5. Complete Parts D and E by answering questions about medical facts and the amount of time needed for leave. Be specific about treatment schedules and any job functions affected.
6. Finally, ensure that all sections are signed and dated appropriately before submitting the form.

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