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Healthcare Providers

Documents and Forms

Role and responsibilities

What is my role as a healthcare provider?

As a healthcare provider, these are your responsibilities:

  1. Determine if your patient’s health condition qualifies them for Paid Family and Medical Leave and how much time off they—or their family members—can receive. The amount of time off is based on medical need.
  2. Complete the Certification of Serious Health Condition form and return it to your patient as soon as possible. You can return it in person, by mail or by fax.

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