FMLA for Doctors and Health Professionals (Medical Certifications)

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CC BY 2.0 | Source


I am not a lawyer, nor do I practice law. I am familiar with FMLA primarily from an employee's perspective through my previous positions, personal experience, and self study.

I have worked as a Family and Medical Leave Act (FMLA) Specialist and provided FMLA services to multiple businesses and organizations. For my article on a general introduction to FMLA, click here. This article will show general examples of how to complete standard FMLA paperwork. There are two forms given by the U.S. Department of Labor:

  • If you are taking leave for your own serious health condition, you will find the form (WH-380-E) here.
  • If you are taking leave for your own serious health condition, you will find the form (WH-380-F) here.

Before going into detail over the forms, it's useful to note some preliminary points.

FMLA and the Health Insurance Portability and Accountability Act (HIPAA) Laws

The FMLA certification is written to be sufficiently vague, so that HIPAA laws are not violated. You can answer the questions providing only an estimation of treatment and/or absences. This information cannot be reliably linked to specific diagnoses unless specifically stated.

The goal then is to be as vague about the condition as possible while providing as much detail on the absences from work as you are capable of.

For the love of science and medicine, do not, please, do NOT tell me that you aren't a mind-reader/fortune-teller/genie. In your expert medical opinion, drawing on however many years of experience, guess. Typically, the paperwork can be adjusted and resent later.

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CC BY 2.0 | Source

When to guess

Of course you should be as precise as possible, but employees often have deadlines for paperwork once their case is reported, along with deadlines to report their medical issues requiring absence. This means that a surgery date for example can be scheduled far in advance. The employee needs to alert their employer ASAP. They then have 15 days to get supporting paperwork to the company, a deadline provided by the employer. You would need to certify the date of surgery and the recovery period.

The recovery period is dependent on how well the surgery goes, and every patient is different. However, it's common that a hysterectomy requires 6-8 weeks of recovery time. Guess for 8 weeks! If you feel uncomfortable, certify for 1-2 weeks post surgery, then adjust the paperwork for additional time as needed upon the follow up appointment.

Pregnancy: you can put the estimated date of delivery and adjust the paperwork once the baby is born.

Migraines: of course you can't know when a patient will have a migraine, but you do have access to the patient's medical history. The patient may report a migraine twice a month on average. You can put 2 "episodes" (migraines) per month.

Asthma: same as above, ad nauseum.

Keep in mind that if the employee exceeds their frequency, the employer may ask that they re-certify. This means that you will need to either confirm their previous frequency or increase it. You may want to give an overestimation as much as you feel is comfortable and correct.

Three Types of FMLA Leave

  • Continuous Leave of Absence: one block of time, generally considered to be 3+ days. You can have multiple, consecutive continuous leaves.
  • Intermittent Leave of Absence: Any regular interval of absences that don't follow a schedule. This can mean an hour appointment once a month or even several days a year.
  • Reduced Leave of Absence: When leave is scheduled, similar to intermittent leave. This can be when employees can only work 4 hours a day maximum, miss every Monday/Wednesday, or similar.

Continuous FMLA Leave

Section 1 and section 2 are not to be completed by the healthcare providers.

Continuous FMLA leave paperwork, page 1
Continuous FMLA leave paperwork, page 1 | Source

You can put the date you began treating the patient, but it is best to put what is in their medical history.

Part A covers basic medical information, when you treated the patient, when the condition began, etc.

Continuous FMLA leave paperwork, page 2
Continuous FMLA leave paperwork, page 2 | Source

Part A: Medical Facts

Regarding Part A, section 4, this is often left blank because healthcare providers feel uncomfortable releasing this kind of information. However, this can be an area to identify specific needs for the patient. Some employers look so carefully at the amount of leave taken that employees have been penalized for "excessive bathroom breaks". During pregnancy, this is often a concern. You can put information like this here.

Continuous FMLA leave paperwork, page 3
Continuous FMLA leave paperwork, page 3 | Source

Part B: Amount of Leave Needed

Part B is the most important part, particularly section 5; it certifies the block of leave needed for the surgery. The only special part about this is that the doctor has certified for appointments, both pre-op and post-op. This is an intermittent leave, which will be covered in more detail below. For continuous leave, all that really matters is section 5.

Continuous FMLA leave paperwork, page 4
Continuous FMLA leave paperwork, page 4 | Source

Intermittent FMLA Leave

The form is the same as this is for an employee's own health condition. The first page is general information not required to be completed by the healthcare provider.

Intermittent FMLA leave paperwork, page 1
Intermittent FMLA leave paperwork, page 1 | Source
Intermittent FMLA leave paperwork, page 2
Intermittent FMLA leave paperwork, page 2 | Source

Part A: Medical Facts

  • Note the approximate start of the condition, this can sometimes be the date you started to treat the patient, and you may make this explicit in the details.
  • "Probable duration of the condition:" The condition is asthma, and in this case, the condition is lifelong. Some companies don't mind if you put lifelong, others do. The law gives a guideline of one year for all paperwork. To avoid trouble and re-certification, you can put '1 year,' or better yet, a specific date. If you wish to be clear, you can indicate that the condition is lifelong.
  • Use the additional space for more information if you feel it is needed. There's no need to state the condition. You can also discuss this with the patient.

Intermittent FMLA leave paperwork, page 3
Intermittent FMLA leave paperwork, page 3 | Source

Adjusting Leave*

Most companies will accept previously completed FMLA paperwork with minor changes. For example, you could scratch out the frequency listed under section 7 and write a 5 instead of 3. You could then initial your name next to the change and resend the documents. In some cases however you will need to complete new paperwork.

Part B: Amount of Leave Needed

Section 5 is for continuous leave, and isn't needed for intermittent leave. Section 6 hasn't been completed, because the leave from work will be random due to asthma attacks. Also, treatments and appointments can be scheduled around work, so no appointments are certified for. This section could be completed if appointments are necessary, in the same was as section 7.

Section 7 is for flare-ups, such as asthma attacks, migraines, low blood sugar, etc. Here it is listed as 3 times per month, lasting one day. This can easily be changed to 3 times per week, or 3 times per 2 months. If you'd like to note anything special about the leave taken, such as different time intervals, please do so in the notes.

The spring months may cause more flare-ups due to the pollen in the air, and the patient may have to take leave more than expected. When this happens, you can adjust the leave as needed at that time when you have a better estimation.*

Intermittent FMLA leave paperwork, page 4
Intermittent FMLA leave paperwork, page 4 | Source

Reduced FMLA Leave

Reduced schedules are a mix of continuous and intermittent leave. The leave is known ahead of time but is generally less than 3 days. This is helpful when you know the patient shouldn't stand for more than 4 hours a day, then they will need to be reduced to working part-time, 20 hours a week. There can also be intermittent leaves plus reduced leaves. When making a determination, if it can be planned, make it reduced. If it's spontaneous, make it intermittent. *For more on determinations, see below.

Reduced FMLA leave paperwork, page 1
Reduced FMLA leave paperwork, page 1 | Source

FMLA For a Family Member

In this case, the patient has listed the situation, and the doctor is agreeing to what's requested. This may make you uncomfortable as the healthcare provider, because you are certifying for the patient's caregiver and not for the patient, them self. However, this is what is expected under the law. You can simply certify what kind of care is likely needed for a patient with that condition. Even simple tasks such as bathing, feeding, etc. can be given an estimated amount of time. Try to think of it in these terms, and you should be able to medically justify any leave the caregiver truly needs.

Reduced FMLA leave paperwork, page 2
Reduced FMLA leave paperwork, page 2 | Source

Part A: Medical Facts

We certify the start date as 12/13/13 and the end date as 12/12/14, i.e. one full year. We can do this even though we may need to renew for another year, or sadly, even though the patient may pass away after a few more months.

You may choose to leave section 3 blank.

Reduced FMLA leave paperwork, page 3
Reduced FMLA leave paperwork, page 3 | Source

Part B: Amount of Leave Needed

The most important thing to remember about this section is that you are completing it for the caregiver, the employee, not the patient. You will need to use the medical facts surrounding the patient to certify leave taken.

Section 4:

Estimating the dates of incapacity: this will be the length of time the employee will be allowed to take leave.

"During this time, will the patient need care?" If you check no, the employee will be denied leave, because you've said the patient doesn't have a severe enough need.

"Explain the care needed by the patient and why such care is medically necessary."
Here, you may wish to list all daily needs if the patient is so incapacitated, e.g. bathing, transportation, feeding, etc. It can be as simple as "transportation to appointments." You can also list it as medically necessary for the patient's recovery. This section will depend on how critically the company examines the medical certification.

Section 5:

This section concerns treatments and appointments. Whenever the patient is receiving this type of care, it should be listed as closely as possible. For example, the caregiver may need to drive home to administer an insulin shot. This can be listed based on how many times a week the shots need to be given. The caregiver may need to drive home from work to deliver them.

Section 6:

This is regarding episodes of incapacity, a flare up that occurs suddenly. See the example given. You may also like to look at the intermittent leave for the employee's own health condition.

Reduced FMLA leave paperwork, page 4
Reduced FMLA leave paperwork, page 4 | Source

Part B: Amount of Leave Needed

Section 7:

This section is for emergency situations, such as asthma attacks, low blood sugar, etc. For this leave, it isn't necessary. In other situations it may be, so please see above under "Intermittent FMLA Leave" for examples.

Additional Comments:

Anything you feel should be known. There is no need to list the condition here.

Different Types of FMLA Forms

The Department of Labor forms aren't necessary to approve FMLA, legally. Many companies will accept multiple forms or offer their own. The main concern is getting the information communicated. Some companies will accept the information if it's legible on a napkin! You can use the above forms and examples as templates. Every situation is different, but as long as common sense is exercised with an eye towards the needs of all parties involved, everything should be fine.

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