Transcription of CIGNA Leave SolutionsSM
{{id}} {{{paragraph}}}
Example: bachelor of science
CIGNA Leave SolutionsSM
CIGNA Leave Solutions Certification of Health care Provider for Pregnancy Disability Leave /Employee s Serious Health Condition (Family and Medical Leave Act) _____ Complies with DOL Form WH-380-E Revised January 2009 Date Prepared: Must Be Returned By: Employee Name: Employer Name: Leave ID: Reason for requesting Leave : Leave date(s)/Period(s) requested: SECTION I: For Completion by the EMPLOYEE INSTRUCTIONS to the EMPLOYEE: Please complete Section I before giving this form to your medical provider. The FMLA permits an employer to require that you submit a timely, complete, and sufficient medical certification to support a request for FMLA Leave due to your own serious health condition.
CIGNA Leave Solutions® Certification of Health Care Provider for Pregnancy Disability Leave/Employee’s Serious Health Condition (Family and Medical Leave Act)
Loading..
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: