Fmla/cfra Med-Cert Certification Of Health (Page 3 of 7) in pdf

APPENDIX C

A “Serious Health Condition” means an illness, injury, impairment, or physical or mental condition that

involves one of the following:

1. Hospital Care

Inpatient care (i.e., an overnight stay) in a hospital, hospice, or residential medical care facility, including any period

of incapacity

or subsequent treatment in connection with or consequent to such inpatient care.

2. Absence Plus Treatment

(a)

A period of incapacity

of more than three consecutive calendar days (including any subsequent

treatment or period of incapacity

relating to the same condition), that also involves

(1)

Treatment

two or more times by a health care provider, by a nurse or physician’s assistant

under direct supervision of a health care provider, or by a provider of health care services (e.g.,

physical therapist) under orders of, or on referral by, a health care provider; or

(2)

Treatment by a health care provider on at least one occasion which results in a regimen of

continuing treatment

under the supervision of the health care provider.

3. Pregnancy

Any period of incapacity due to pregnancy, or for prenatal care.

4. Chronic Conditions Requiring Treatments

A chronic condition which:

(1)

Requires periodic visits for treatment by a health care provider, or by a nurse or physician’s assistant

under direct supervision of a health care provider;

(2)

Continues over an extended period of time (including recurring episodes of a single underlying

condition); and

(3)

May cause episodic rather than a continuing period of incapacity

(e.g., asthma, diabetes, epilepsy,

etc.).

5. Permanent/Long-Term Conditions Requiring Supervision

A period of incapacity

which is permanent or long-term due to a condition for which treatment may not be

effective. The employee or family member must be under the continuous supervision of, but need not be

receiving active treatment by, a health care provider. Examples include Alzheimer’s, a severe stroke, or the

terminal stages of a disease.

6. Multiple Treatments (Non-Chronic conditions)

Any period of absence to receive multiple treatments (including any period of recovery therefrom) by a health care

provider or by a provider of health care services under orders of, or on referral by, a health care provider, either for

restorative surgery after an accident or other injury, or for a condition that would likely result in a period of

incapacity

of more than three consecutive calendar days in the absence of medical intervention or

treatment, such as cancer (chemotherapy, radiation, etc.), severe arthritis (physical therapy), kidney disease

(dialysis).

Treatment includes examinations to determine if a serious health condition exists and evaluations of the condition.

Treatment does not include routine physical examinations, eye examinations, or dental examinations.

A regimen of continuing treatment includes, for example, a course of prescription medication

(e.g., an antibiotic) or therapy requiring special equipment to resolve or alleviate the health condition. A regimen of

treatment does not include the taking of over-the-counter medications such as aspirin, antihistamines, or salves; or

bedrest, drinking fluids, exercise, and other similar activities that can be initiated without a visit to a health care

provider.

Fmla/cfra Med-Cert Certification Of Health Page 3

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