Certification of Health Care Provider for Employee s ...
certification to support a request for CTFMLA leave due to the serious health condition of the employee. For CTFMLA purposes, a “serious health condition” means an illness, injury, impairment, or physical or mental condition that involves inpatient care or continuing treatment by a health care provider. For more information about the ...
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www.yccd.edumay require an employee seeking FMLA protections because of a need for leave to care for a covered family member with a serious health condition to submit a medical certification issued by the health care provider of the covered family member. Please complete Section I before giving this form to your employee. Your response is voluntary.