Health care providers

Be there for your patients and their families.

Want to receive updates from us? Subscribe to our Paid Leave — Health Care Coordinators & Community Workers newsletter.

Subscribe.

Health Care Providers

A health care provider is someone licensed to practice medicine or surgery according to your state’s laws. This includes:

  • Physicians and osteopathic physicians
  • Nurse practitioners
  • Physician assistants
  • Nurse-midwives and midwives
  • Clinical social workers
  • Clinical psychologists
  • Optometrists
  • Physical therapists
  • Podiatrists
  • Dentists
  • Chiropractors under limited circumstances, and
  • Other healthcare providers identified in  RCW 50A.05.010 or WAC 192-500-090.

As a health care provider, you are responsible for:

Determining if your patient’s health condition qualifies them for Paid Leave and how much time off they—and their family members—can receive.

The amount of time off is based on medical need.

Patients or their family members do not have to use all their leave at once.

You determine the start and end dates of the serious health condition.

For medical conditions lasting longer than a year, enter a date one year in the future as the end date on the form.

Completing and returning the certification form.

Give it to your patient or their family member within 7 calendar days after you receive the form so they can send it to us.

You cannot charge a fee for completing the form.

If you need to make corrections to the form, cross out the previous information, write in the new information then initial the changes. We cannot accept forms with white out.

Your patient or their family member complete section one. You complete section two, where you certify the serious health condition and sign the form.

It may help to keep copies of the form in your office to support your patients and their family members.

Note: If your patient or their family member prefers, they can use a Family Medical Leave Act (FMLA) form or a note from you instead, but it must include the information required by WAC 192-610-020.

Medical Leave Certification

Family Leave Certification

Pregnancy and Birth Certification

Authorizing a designated representative if your patient is incapable of doing so themselves.

You must complete the Designated Authorized Representative form (available by contacting our Customer Care Team at 833-717-2273) and attest that:

  • Your patient is incapable of completing the administrative requirements necessary for receiving Paid Leave benefits,
  • Your patient is unable to designate an authorized representative on their behalf, and
  • You are acting in your patient’s best interest.

The laws that apply are RCW 50A.05.010(14), RCW 50A.05.010(23) and WAC 192-800-150.