FMLA Packet of Information (Family Member's Condition)

Overview

The Family and Medical Leave Act (FMLA) packet is designed to provide healthcare providers with the necessary information to support an employee’s request for medical leave to care for a family member. This ensures that the family member’s condition meets the criteria for FMLA leave.

Notice of Eligibility & Rights and Responsibilities under the Family and Medical Leave Act (Family Member's Condition)

  1. Notice of Eligibility & Employees Rights: Provides employees with required information about their eligibility for FMLA leave, outlines their rights and responsibilities, and must be given within five business days of notifying the employer about the need for FMLA leave, provided the employee meets the service and hours requirements.

  2. Medical Certification Form: This form must be completed by the healthcare provider to certify the family member’s serious health condition and the need for the employee to provide care.

Designation Notice under the Family and Medical Leave Act

Download and complete the FMLA Designation Notice form to designate FMLA leave.

HR Generalists: HR generalists may now send FMLA information, including the full packet, via email. This method speeds up the process and eliminates the cost of certified mail. Read the procedures for emailing FMLA information. 

Instructions for the Employee

This packet contains important information and forms related to your request for FMLA leave. Please follow these steps:

  1. Review the Information: Carefully read through all the documents in this packet to understand your rights and responsibilities under the FMLA.

  2. Consult Your Physician: Take the Medical Certification Form, and ADA Packet Documents to your healthcare provider. They will need to complete the form based on their knowledge of your family member’s medical condition.

  3. Complete the Forms: Ensure that all sections of the Medical Certification Form are filled out accurately by your healthcare provider.

  4. Return the Paperwork: Once the forms are completed, return them to your HR Professional as soon as possible to avoid any delays in processing your leave request.

If you have any questions or need further assistance, please Ask an FMLA/Parental Leave Question.

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FMLA/Parental Leave
The Family and Medical Leave Act (FMLA) is a benefit that allows qualified employees to have up to 12 weeks of unpaid leave per fiscal year. Employees on maternity or paternity leave that do not qualify for FMLA qualify for Parental Leave.