Form DOP-L5 Supplemental Certification of Health Care Provider for Employee's Serious Health Condition - Medical Leave of Absence Without Pay and / or Federal Family and Medical Leave Act (Fmla) - West Virginia

What Is Form DOP-L5?

This is a legal form that was released by the West Virginia Division of Personnel - a government authority operating within West Virginia. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form DOP-L5?
A: Form DOP-L5 is a Supplemental Certification of Health Care Provider for Employee's Serious Health Condition specifically for Medical Leave of Absence Without Pay and/or Federal Family and Medical Leave Act (FMLA) in West Virginia.

Q: Who needs to complete Form DOP-L5?
A: Form DOP-L5 needs to be completed by the employee's health care provider.

Q: What is the purpose of Form DOP-L5?
A: The purpose of Form DOP-L5 is to certify the serious health condition of the employee and support their request for Medical Leave of Absence Without Pay and/or FMLA.

Q: When should Form DOP-L5 be submitted?
A: Form DOP-L5 should be submitted as soon as possible after the need for leave arises, but no later than 15 calendar days from the date of the request.

Q: Are there any specific requirements for completing Form DOP-L5?
A: Yes, the health care provider must provide detailed information about the employee's condition, including diagnosis, prognosis, and treatment plan.

Q: What happens after Form DOP-L5 is submitted?
A: After Form DOP-L5 is submitted, the employee's request for Medical Leave of Absence Without Pay and/or FMLA will be reviewed and a determination will be made.

Q: Is there a fee for submitting Form DOP-L5?
A: No, there is no fee for submitting Form DOP-L5.

Q: What are the consequences of providing false information on Form DOP-L5?
A: Providing false information on Form DOP-L5 may result in disciplinary action, including denial or revocation of the employee's leave of absence.