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Updates to the PFML Certification of your Serious Health Condition form

New Members

As part of our continuous improvement objective, the Department of Family and Medical Leave (DFML) has updated their Certification of your own Serious Health Condition form. The changes clarify the information required to complete the form and reduce the need for corrected information.  This should result in greater efficiency for medical providers, make it easier for you to review the information provided, and shorten the approval timeline.

  • Question 8 has been split into two separate questions with simpler language and more targeted examples. It makes a distinction between the medical facts making the patient unable to work and job functions that they cannot perform. 
  • Question 11 has been reformatted to allow the medical provider to provide the number of weeks needed for a serious health condition related to pregnancy, recovery from childbirth, or post-natal recovery. 
Learn more about the improved form.
Please feel free to share the information about these changes with your professional colleagues.

Department of Family & Medical Leave
(833) 344-7365 from 8am–5pm ET

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