How to Fill Out the Family Medical Leave Act Form

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Once you have gotten over the shock of having a debilitating disease such as diabetes, heart issues, fibromyalgia, or any other illness your doctor deems serious, it is time to have an FMLA (Family Medical Leave Act) form on file with your employer. Having the form on file protects you from being placed on the disciplinary track every time you are ill with that disease. This also applies to a family member whose care you are responsible for such as a parent, spouse, child or grandparent.

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Instructions

Difficulty: Moderately Easy

Things You’ll Need:

Certification of Physician or Practitioner (FMLA) form
Pen (black or blue)
Physician's appointment

Step1

Obtain the FMLA form from your office manager or secretary. They should have these on file because the Family and Medical Leave Act has been in force since 1993.

Step2

If you are the primary caretaker of a family member who is ill, you should have a form on file for that reason too. There will be times you have to take off work for that family member and this will protect you from unexcused absences.

Step3

There is a section on the form which needs to be filled out by the employee (you) who is in need of the FMLA form to care for a seriously-ill family member. That is where you will give a general idea to your employer as to how long you will need the leave, or if the leave will be intermittently taken.

Step4

Make an appointment with your physician or medical practitioner to go over the form and have the portion requiring their input filled out.

Step5

Be sure that you and the physician or practicioner sign the form and the physician specifies their type of practice or field of specialization.

Tips & Warnings

Make a copy of the form and keep it in a safe place.
Turn the original form in to your employer immediately.
Be sure to write that there is an FMLA form on file whenever you take time off for yourself or your family member, on your leave request form and keep a copy of that for your files as well.
Remember that the Privacy Act protects you from having to write down the exact nature of your illness. Your physician should know this and will not disclose the nature of your illness, only the primary problems of it.