- Grants up to 12 weeks leave in a 12-month period
- Leave Granted for one or more of the following reasons:
- Birth of a child and care after such birth for either parent
- Placement of child for adoption or foster care for either parent
- Serious health condition of spouse, child or parent of employee
- Serious health condition of employee (unable to perform job)

- Handbook of Operating Procedures FMLA Policy

Sick and Vaction Leave

- Employees must exhaust all sick leave and vacation leave, if applicable, when taking FMLA
- Paid leave counts against the 12-week FMLA entitlement

- Medical Foundation continues to contribute its share of premium sharing for insurance at the department's expense

- 30 days or as soon as practical
- Verbal notice is sufficient
- Department may require certification from the health care provider

FMLA Forms

Certification of Health Care Provider - to be completed by health care provider, signed by employee and returned to residency coordinator. 

Request for Family or Medical Leave - to be completed by employee and returned to residency coordinator. 

Certification of Fitness for Duty - to be completed by health care provider and returned to residency coordinator upon return to work.

Time Log - to be maintained by residency program timekeeper.

FMLA Sample Letters - (Downloadble Word Documents - may be edited to fit specific situations.)

FMLA Certification Request Letter -  Letter from supervisor to employee requesting completion of the Certification of Health Care Provider Form.

FMLA First Letter for Illness -   Letter from supervisor to employee regarding FMLA.

FMLA First Letter (Baby) - Letter from supervisor to employee regarding FMLA available for pregnancy leave. 

FMLA Middle Letter -  Follow-up FMLA letter from supervisor to employee. 

FMLA Extension Letter -  Letter from supervisor to employee regarding FLMA expiration and options available if additional time is needed.

Human Resources Advising Team

Emil Dela Cruz - Insurance & Benifits Questions - 713-500-5247

April A. Bass - Leave of Absence Paperwork - 713-500-5154