Renown Nursing Team

Family Medical Leave Act (FMLA) Paperwork

FMLA Paperwork: What You Need to Know

The Family Medical Leave Act (FMLA) entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave.

Standard processing time for FMLA is 8-10 days from the moment received by the coordinator. This is because our physicians work seven days on and seven days off. We cannot complete intermittent or disability leave of any kind. A copy of the signed and completed FMLA will be emailed to the patient/family to the email provided in the contact form, unless otherwise stated, within 3-5 business days.

Please fill out the form below with your contact information to ensure you can be contacted and receive your FMLA paperwork. This form is intended to be completed by patients who had an in-patient visit at a Renown Health hospital.

Return to Work Notes

Need a return to work note? Please email the Hospitalist Administrative Team.
Benefits at Renown

About Us Frequently Asked Questions

  • What family members qualify for FMLA leave?
    • Parent: A biological, adoptive, step or foster father or mother, or someone who stood in loco parentis to the employee when the employee was a son or daughter. Parent for FMLA purposes does not include in-laws.
    • Spouse: A husband or wife defined or recognized in the state where the employee was married and includes individuals in a same-sex marriage or common law marriage.
    • Son or Daughter: For leave other than military family leave, a biological, adopted, or foster child, a stepchild, a legal ward, or a child of a person standing in loco parentis who is either under 18 years of age, or 18 or older and incapable of self-care because of a mental or physical disability.
  • Do I have to use my employer's certification forms?
    No, employers must accept a complete and sufficient certification, regardless of the format. The employer cannot reject a certification that contains all the information needed to determine if the leave is FMLA-qualifying. The employe cannot refuse. (Wage and Hour Division - An agency within the US Department of Labor, n.d.)
  • Can old or expired Department of Labor (DOL) forms be used?

    Yes. The FMLA does not require the use of any specific form or format.