Certification of Health Care Provider for Family Member's Serious Health Condition (Family and Medical Leave Act) - Delaware

Certification of Health Care Provider for Family Member's Serious Health Condition (Family and Medical Leave Act) - Delaware

Certification of Health Serious Health Condition (Family and Medical Leave Act) is a legal document that was released by the Delaware Department of Human Resources - a government authority operating within Delaware.

FAQ

Q: What is the Certification of Health Care Provider for Family Member's Serious Health Condition?
A: It is a form required by the Family and Medical Leave Act (FMLA) in Delaware to certify the serious health condition of a family member for whom an employee is requesting leave.

Q: Who needs to complete the Certification of Health Care Provider form?
A: The form needs to be completed by the health care provider of the family member who has a serious health condition.

Q: What does the Certification of Health Care Provider form ask for?
A: The form asks for information about the family member's medical condition, the expected duration of the condition, and the treatment being received.

Q: Do I need to submit the Certification of Health Care Provider form to my employer?
A: Yes, you need to submit the completed form to your employer to support your request for Family and Medical Leave Act (FMLA) leave.

Q: Can my employer contact the health care provider to verify the information on the Certification of Health Care Provider form?
A: Yes, your employer has the right to contact the health care provider to authenticate the information provided on the form.

Q: Is the information on the Certification of Health Care Provider form confidential?
A: Yes, the information on the form is confidential and should be kept separate from an employee's personnel file.

Q: What happens if I fail to provide a completed Certification of Health Care Provider form?
A: If you fail to provide a completed form, your employer may deny your request for Family and Medical Leave Act (FMLA) leave.

Q: Can I be required to provide additional medical documentation besides the Certification of Health Care Provider form?
A: Yes, in some cases, your employer may request additional medical documentation to verify the need for FMLA leave.

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Form Details:

  • Released on November 20, 2019;
  • The latest edition currently provided by the Delaware Department of Human Resources;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Delaware Department of Human Resources.

Download Certification of Health Care Provider for Family Member's Serious Health Condition (Family and Medical Leave Act) - Delaware

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