An employer may require an employee requesting FMLA leave to care for a current servicemember to obtain certification from an authorized health care provider of that servicemember that provides:

• The name, address, telephone number, fax number and/or e-mail address of the health care provider;
• The type of medical practice;
• The medical specialty;
• The type of authorized health care provider (See previous screen, Military Caregiver Leave Certification – Authorized Health Care Provider);
• Whether the current servicemember’s injury or illness was incurred in the line of duty on active duty or, if not, whether the current servicemember’s injury or illness existed before the beginning of the servicemember’s active duty and was aggravated by service in the line of duty on active duty;
• The approximate date on which the injury or illness commenced or was aggravated, and its probable duration;
• A statement or description of appropriate medical facts regarding the current servicemember’s illness or injury for which FMLA leave is requested, including information on whether the injury or illness may render the servicemember medically unfit to perform the duties of his or her office, grade, rank or rating, and whether the servicemember is receiving medical treatment, recuperation or therapy;
• Information sufficient to establish that the servicemember is in need of care and whether he or she will need care for a single continuous period of time (including any time for treatment and recovery) and an estimate as to the beginning and ending dates for this period of time;
• If an employee requests leave on an intermittent or reduced schedule basis for planned medical treatment appointments, whether there is a medical necessity for the servicemember to have such periodic care and an estimate of the treatment schedule of such appointments; and,
• If an employee requests leave on an intermittent or reduced schedule basis for unscheduled care (for example, episodic flare-ups of the injury or illness), whether there is a medical necessity for the servicemember to have such periodic care (which can include assisting in recovery) and an estimate of the frequency and duration of the period of care.

The authorized health care provider may, as needed, rely on certain military-related determinations made by an authorized DOD representative (such as a DOD Recovery Care Coordinator).

In all instances when a certification is requested, it is the employee’s responsibility to provide the employer with a complete and sufficient certification. Failure to do so may result in the denial of FMLA leave.

Continue to Military Caregiver Leave Certification – Required Information from the Employee or Servicemember or Return to Military Family Leave Certifications.