Family Medical Leave Act (FMLA) Paperwork


Family Medical Leave Act (FMLA) Paperwork Examples

Do I qualify for medical leave for weight loss surgery?
Please check with your human resources department with your employer to determine if you are eligible for FMLA leave.

Where do I obtain FMLA paperwork?
Your employer should provide you with the appropriate paperwork.

When should I get my FMLA paperwork completed?
Please view the examples above for assistance in completing your FMLA paperwork. You are expected to complete your portion of the document prior to submission to the surgeon's office for completion. Bring your completed FMLA documents with you to your preoperative Bariatric Nurse visit.

Where do I send my FMLA paperwork to be completed for submission to my employer?
Please give your completed FMLA documents to the CMA or nurse at your bariatric visit for one of our healthcare providers to sign them. You will then be responsible for returning them to your employer.

What part of the FMLA paperwork do I need to complete?
In general, all FMLA paperwork contains the same text, but each employer typically has a slightly different version. Most contain numbered boxes.

You should fill in boxes 1, 2, 3, 4, 5a, 5b, 6a, 7b, and provide the type of practice ("Surgery"), the address of the surgical practice, and our telephone number. Please refer to the examples provided above as well as the instructions on your FMLA documents. We are not able to complete your documents without your assistance.

How does my FMLA paperwork get to my employer?
You will return your paperwork to your employer. Please ensure that you have filled out all sections to the best of your ability according to the instructions provided in the examples so that we can do this during your visit.

Where can I fax FMLA paperwork that I have filled out already and just need a healthcare provider signature?
You will need to bring your paperwork in person to your appointment.

 


 
 

Central Scheduling: 612.672.7422

Provider Referrals: 612.672.7000

Administrative Offices: 612.884.0600
 

©2012 Regents of the University of Minnesota. All rights reserved.