Nalc Form 1 - Medical Certification - Employee'S Own Serious Health Condition (Page 2 of 2) in pdf

“Serious Health Condition”

Definition under the Revised Family and Medical Leave Act

A “serious health condition” of a family member is

4. Chronic conditions requiring treatments:

defined in the FMLA regulations as any illness, injury,

A chronic condition which

impairment or physical or mental condition that involves

one of the following:

a. Requires periodic visits

for treatment by a

health care provider, or by a nurse under direct supervi-

1. Hospital care:

sion of a health care provider;

This means inpatient care (that is, an overnight stay) in a

b. Continues over an extended period of time

hospital, hospice or residential medical care facility,

(including recurring episodes of a single underlying

including any period of incapacity or subsequent treat-

condition); and

ment in connection with or consequent to such inpatient

c. May cause episodic rather than a continuing peri-

care.

od of incapacity (e.g., asthma, diabetes, epilepsy).

2. Absence plus treatment:

5. Permanent/long-term conditions requiring

A period of incapacity

of more than three full consec-

supervision:

utive calendar days (including any subsequent treat-

A period of incapacity which is permanent or long-

ment or period of incapacity relating to the same condi-

term due to a condition for which treatment may not be

tion), that also involves:

effective. The employee or family member must be

under the continuing supervision of, but need not be

a. Treatment

two or more times

by a health care

receiving active treatment by a health care provider.

provider, by a nurse under direct supervision of a health

Examples include Alzheimer’s, a severe stroke, or the

care provider, or by a provider of health care services

terminal stages of a disease.

(e.g., physical therapist) under orders of, or on referral

by, a health care provider; or

6. Multiple treatments (non-chronic conditions):

Any period of absence to receive multiple treatments

b. Treatment (in person visit) by a health care

(including any period of recovery therefrom) by a health

provider on at least one occasion

which results in a

care provider or by a provider of health care services

regimen of continuing treatment

under the supervi-

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

sion of the health care provider.

either for restorative surgery after an accident or other

injury, or for a condition that would likely result in a

3. Pregnancy:

period of incapacity of more than three consecutive

Any period of incapacity due to pregnancy or for pre-

calendar days in the absence of medical interven-

natal care.

tion or treatment such as cancer (chemotherapy, radia-

tion, etc), severe arthritis (physical therapy), kidney dis-

ease (dialysis).

“Incapacity,” for purposes of the FMLA, is defined to mean inability to work, attend school or perform other

regular daily activities due to the serious health condition, treatment therefrom, or recovery.

“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.

“Two or more times” must be within 30 days of beginning period of incapacity and the first visit must be within 7

days of the first day of incapacity.

“one occasion” must be within 7 days of the first day of incapacity.

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 bed-rest, drinking

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

“Periodic visits” must include at least 2 visits a year.

NALC Form 1 (page 2 of 2) - 5/24/2013

Nalc Form 1 - Medical Certification - Employee'S Own Serious Health Condition Page 2

Related Articles

Related forms

Related Categories