Creating a Medical Certification Form
Create a Medical Certification Form
• Complete the applicable Certification Form. For example, if the FMLA leave is being requested for the employees own serious health condition:
Click the “Not Done – Create” button next to “Employee’s Serious Health Condition.”
Note: Certain certification forms will or will not be available depending on the reason FMLA leave is being requested. For example, if the reason for leave is the employee’s own serious health condition, only that medical certification will be available. If the reason for leave is to care for a covered family member with a serious health condition, only that certification will be available. If the reason for leave is birth of a child, both medical certifications will be available. If leave is for birth of a child, use the Employee’s Serious Health Condition form for the expectant mother, and Family Member’s Serious Health Condition form for the mother’s spouse only if the spouse is seeking FMLA leave to care for his or her spouse for pregnancy or recovery from childbirth. If the spouse or non-birth parent is seeking leave to care for a healthy newborn, no certification may be required. Similarly, if leave is for placement of a child for adoption or foster care, no certification may be required (but other documentation may be required).
- Select the medical certification due date, which will be the same date as you selected on the Eligibility Notice.
- If leave is for the employee’s own serious health condition, the employee’s job title and regular weekly work schedule are required fields.
Whether to attach a job description is optional.
If you wish to include the employee’s job description along with the medical certification form that is sent to the employee electronically, change the defaulted selection to indicate that the “Job Description” is attached in section number 4.
Note: If you select the option to include a job description, make sure to upload the
employee’s job description in the employee’s EFI profile and select “Job Description” to
include when emailing, make sure to select the job description as one of the documents to
send the employee.
The “Statement of the Employee’s Essential Job Functions” also is optional.
If the certification is the initial certification related to the employee’s leave request, leave “Initial
Certification” selected. If the certification is not the initial medical certification being requested,
select the type of certification that is being requested (e.g., recertification, second opinion).
After completing the employer portion of the medical certification form,
click “Finish” to view the certification form.
Scroll down to the bottom of the page and click “Return to Profile”.
Click here to learn how to Electronically Send Notices, Forms, Other Documents or Print