- 1). Select the correct form. If you, the employee are undergoing a particular illness there is a form for that, which has the words "Certification by Employee's Healthcare Provider for Employee's Serious Illness - FMLA" at the top. If the illness involves a family member, you need a form that says "Health Care Provider Certification of Employee's Family Member Serious Illness -FMLA" at the top.
- 2). Write the employee's name at the top. If the employee is not the patient, write down the patient's name and relationship to the employee. Write down the type of illness that is occurring to the employee or family member. Pregnancy, while not an illness, is an acceptable condition under the Act.
- 3). Turn over the form and read the descriptions of serious medical conditions. While it might be hard to find a description that fits what you're going through exactly, pick the one that describes your situation most closely. Note the number next to the description. Turn the form over and put an "X" next to the number that describes your medical situation.
- 4). Explain your absence. Write down if you'll be leaving intermittently during flare-ups when you won't be able to work, or if you'll be leaving for large chunks of time for planned treatment. If you're the one that's ill, explain if you can currently perform the duties of your job or how the situation has affected your ability to perform your job.
- 5). Write down the dates of your planned absence and the date of your planned return. While it's hard to estimate with your health, you may want to give yourself extra time for recovery. Write down the name of your health care provider, his specialty and practice, and his phone and fax number. Some employers will want to corroborate with your doctor.
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