Healthcare providers

Be there for your patients.

Learn about your critical role

Paid Family and Medical Leave provides paid time off for Washington workers when they need it most. If a patient of yours is experiencing a serious health condition that prevents them from working or has just given birth to a baby, you play a critical role in helping them access paid time off to rest, heal and recover.

Your role and responsibilities

If a patient of yours experiences a serious health condition that prevents them from working, it’s your job to confirm their medical need for paid time off and to determine how much time off they or their family members can take.

The Certification of Serious Health Condition form is designed to collect all the medical information needed for someone to qualify for paid leave. Your patients can also use a Family Medical Leave Act form or a doctor’s note as long as it includes the same information as the Certification of Serious Health Condition form.


Who qualifies as a healthcare provider?

A healthcare 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

How do people qualify for paid leave?

For someone to qualify for paid leave, they or their family member must experience a “qualifying event.” From a medical perspective, this includes:

  • A major surgery, serious illness or injury
  • Giving birth to a baby or experiencing complications in pregnancy
  • Receiving treatment for a chronic health condition like diabetes or epilepsy
  • Receiving inpatient treatment for substance abuse or for mental health

A comprehensive list of qualifying events is included with the Certification of Serious Health Conditions form.


Your role: Medical leave

When your patient experiences a qualifying event, your role is to fill out the Certification of Serious Health Condition form (or other documentation that meets the requirements) to confirm your patient’s medical condition and determine the amount of time their condition will limit their ability to work.

Your patient may bring the form into your office—however, you can also download the form and print it yourself. After filling out the appropriate portions of the form, please return it to your patient as quickly as possible because they must include it with their application for Paid Family and Medical Leave.


Your role: Family leave

If your patient’s family member is applying for family leave to care for your patient, you will need to fill out the Certification of Serious Health Condition form or other acceptable documentation for the family member. Fill out the form with information about your patient’s health condition and how much time it will limit your patient’s ability to work. Your patient’s family member will qualify for time off based on this information.

If more than one of your patient’s family members applies for paid leave to care for your patient, you will need to fill out one form for each family member.

Download the Certification of Serious Health Condition form

The Certification of Serious Health Condition form includes all the information needed for Washington’s Employment Security Department to determine if someone applying for Paid Family and Medical Leave has experienced (or has a family member who has experienced) a qualifying medical event.

After filling out the form, please return it to your patient or their family member as quickly as possible. They must include it with their application for paid leave.

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

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