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Question: Does an employer have to use the Department of Labor’s Family and Medical Leave Act (FMLA) forms, or can the employer accept a medical note from the employee’s physician?

Answer: The Department of Labor has developed optional forms for use in obtaining medical certification, including second and third opinions, from health care providers that meet the Family and Medical Leave Act (FMLA) certification requirements. Employers are not required to use these forms, and can certainly create their own or allow an employee to remit a medical note from the employee’s physician.

In general, when leave is taken because of an employee’s own serious health condition or the serious health condition of a family member, an employer should require an employee to obtain a medical certification from a health care provider that sets forth all of the following information:

  1. The name, address, telephone number, and fax number of the health care provider and type of medical practice/specialization.
  2. The approximate date on which the serious health condition commenced, and its probable duration.
  3. A statement or description of appropriate medical facts regarding the patient’s health condition for which FMLA leave is requested. The medical facts must be sufficient to support the need for leave. Such medical facts may include information on symptoms, diagnosis, hospitalization, doctor visits, whether medication has been prescribed, any referrals for evaluation or treatment (physical therapy, for example), or any other regimen of continuing treatment.
  4. If the employee is the patient, information sufficient to establish that the employee cannot perform the essential functions of the employee’s job as well as the nature of any other work restrictions, and the likely duration of such inability.
  5. If the patient is a covered family member with a serious health condition, information sufficient to establish that the family member is in need of care, and an estimate of the frequency and duration of the leave required to care for the family member.
  6. If an employee requests leave on an intermittent or reduced schedule basis for planned medical treatment of the employee’s or a covered family member’s serious health condition, information sufficient to establish the medical necessity for such intermittent or reduced schedule leave and an estimate of the dates and duration of such treatments and any periods of recovery.
  7. If an employee requests leave on an intermittent or reduced schedule basis for the employee’s serious health condition, including pregnancy, that may result in unforeseeable episodes of incapacity, information sufficient to establish the medical necessity for such intermittent or reduced schedule leave and an estimate of the frequency and duration of the episodes of incapacity.
  8. If an employee requests leave on an intermittent or reduced schedule basis to care for a covered family member with a serious health condition, a statement that such leave is medically necessary to care for the family member, which can include assisting in the family member’s recovery, and an estimate of the frequency and duration of the required leave.