CFRA / FMLA Medical Certification Form
This Civil Rights Department form verifies an employee's need for FMLA or CFRA leave due to a serious health condition. It must be completed by the employee's health care provider.
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While the Federal Department of Labor publishes medical certification forms for FMLA leave, employers in California should use California medical certification forms to ensure compliance with California’s specific restrictions on requests for certain medical details, such as diagnosis. The California Civil Rights Department has published certification forms appropriate for leave due to the employee's or a family member's serious health condition and for pregnancy disability.
Employers may require medical certification for CFRA leave due to an employee's serious medical condition or for an employee to care for a family member with a serious medical condition.
Employers may require medical certification for FMLA leave due to an employee's serious medical condition or for an employee to care for a family member with a serious medical condition. Employers may also require certification of FMLA leave to care for a “covered servicemember.”
CFRA certification means the documentation the employer requires from an employee to support the employee’s stated reason for taking CFRA leave. For example, an employer could require CFRA certification from a medical provider to support an employee's request for CFRA leave for their own or a family member's serious health condition.
Employers should provide employees with an appropriate California-compliant form, such as the Cal. Civil Rights Department form, to bring to their own or their family member's health care provider for completion.
It is the employer's responsibility to provide employees with FMLA paperwork. If medical certification is required, the employer should provide the employee with a certification form for this purpose.
Paperwork goes to the employee.
For medical-related family and medical leaves (other than FMLA leave to care for a "covered servicemember"), medical certification must be completed by the patient's healthcare provider and include the date, if known, the serious health condition began, and the probable duration. If the employee is asking for leave due to their own serious health condition, the certification must also include a statement that the employee is unable to work at all or is unable to perform any one or more of the essential functions of their position. If the employee is asking for leave due to a family member's serious health condition, the certification must also include an estimate of the amount of time the employee will need to care for the family member, and a statement that the participation of the employee is necessary.