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

March 23, 2022 1082

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.
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