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Certification of Health Care Provider - Employees or Family Members Serious Health Condition

Use this DFEH form to request certification from a health care provider for CFRA leaves due to the employee’s own serious health condition or that of a family member.

This for may be used for CFRA and non-CFRA medical leaves of absence or other requested accommodations due to a qualifying disability or serious heath condition.
Face Covering Exemption Medical Certification Form

Employers should develop a policy to accommodate any worker who meets one of the exemptions from wearing a face mask. If a worker is unable to wear a mask due to a medical condition, they should be provided with a non-restrictive alternative, such as a face shield with a drape attached to the bottom edge, for example. Employers may provide this form to an employee to obtain medical certification from their health care provider supporting their request for an accommodation.

Travel and other Conduct Away from the Workplace During the COVID-19 Pandemic Policy

State laws restrict employers from regulating where employees can go on vacation, but practice owners can develop a travel policy that includes a pre-travel inquiry and post-travel quarantine that could help protect patients and staff from potential exposure. Once developed, employers should distribute the policy to each employee and retain a signature acknowledgement from each employee. As a best practice, the policy should be universally applied to all employees of the practice.  

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