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FMLA Certification Form for a Family Member

The Family and Medical Leave Act (FMLA) provides that an employer may 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 work closely with your local Human Resource Office Specialist.

Certification HCP_Family Member’s Serious Health Condition

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