Looking for a Fmla Certification Form Templates? Download it for free!

Serious Health Conditions

A “serious health condition” means an illness, injury, impairment, or physical or mental condition that involves one of the

following:

1. Inpatient 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. Incapacity of More Than 3 Consecutive Days Plus

Continuing Treatment by a Health Care Provider

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:

(a) Treatment two or more times by a health care provider, by a nurse or physician’s assistant under direct

supervision of a health care provided, or by a provider of health care services (e.g., physical therapist) under

orders of, or on referral by, a health care provider; OR

(b) 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 (e.g., a course of prescription medication, or

therapy requiring special equipment, to resolve or alleviate the health condition). Note: This does not include

taking over-the-counter medications or activities that can be initiated without a visit to a health care provider

(e.g., bed rest, exercise, drinking fluids).

3. Pregnancy

A period of incapacity due to pregnancy, childbirth, or related medical conditions. This includes severe morning

sickness and prenatal care.

4. Chronic Conditions Requiring Treatment

A chronic condition which:

(a) 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;

(b) Continues over an extended period of time (including recurring episodes of a single underlying condition); and

5. Permanent/Long-Term Conditions Requiring Supervision

A period of incapacity that 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 continuing 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), or kidney disease (dialysis).

3 of 3

Certification Of Health Care Provider For Family Member'S Serious Health Condition - Family And Medical Leave Act ("Fmla") & California Family Rights Act ("Cfra") Page 3