Medical Certification/Doctor's Note
The medical facts appropriate for inclusion on the certification form will vary depending on the nature of the serious health condition and are determined by the health care provider, but must be sufficient to support the need for leave. The information requested may relate only to the serious health condition for which the employee is seeking leave.
- Employees are required to provide supporting medical certification/doctor’s note when requesting to use sick leave.
- A complete and sufficient certification needs to include the following information:
- Contact information for the health care provider, including name, address, telephone number, tax number, and type of medical practice/specialty,
- When the serious health condition began,
- How long the serious health condition is expected to last,
- If the employee is the patient, whether the employee is unable to work, and the likely duration of this inability,
- Whether the employee’s need for leave is continuous or intermittent, and
- Appropriate medical facts about the condition, at the health care provider’s discretion.
Additional information for Intermittent or Reduced Schedule Leave
- For intermittent or reduced schedule leave, additional information in the certification is required, such as:
- the frequency of flare-ups or need for urgent care (times per week/month/year)
- the duration of time the employee will be incapacitated by each occurrence/episode, etc.
- Schedule of treatments/appointments (times per week/month/year)
- Duration of treatments/appointments
- Whether treatments/appointments can be scheduled during non-work hours
- If a part-time/reduced schedule is requested: Whether it is medically necessary for the employee to work a part-time/reduced schedule due to the employee’s serious health condition
- What is the recommended part-time/reduced schedule
- List of restrictions that preclude the employee from performing the essential job functions