Certification of Health Care Provider - Employees or Family Members Serious Health Condition

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Have the employee's health care provider complete this medical certification as needed. This form is used for employee's taking leave under the Family Medical Leave Act (FMLA) and California Family Rights Act (CFRA) for their own serious health condition or that of a family member.​​​​

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    ​To access this pre​mium form, try HRCalifornia.

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