Equal Employment Opportunity (Eeo) Policy And Program Administration Form Sample Page 41

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VA MEDICAL CENTER
POLICY MEMORANDUM 00-304
BRONX, NEW YORK 10468
July 31, 2003
Family and Medical Leave Act — Explanation of Terms
3
Serious Health Condition
means an illness, 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
4
period of incapacity
or subsequent treatment in connection with or consequent to such inpatient care
.
2.
ABSENCE PLUS TREATMENT
2
A period of incapacity
of more than three consecutive calendar days (including any subsequent treatment
2
or period of incapacity
relating to the same condition) that also involves:
5
A. Treatment
two or more times by a health care provider, by a nurse or a 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 referral by, a health care provider; or
3
Treatment
by a health care provider on at least one occasion, which results in a regimen of
B.
6
continuing treatment
under the supervision of a health care provider.
3.
PREGNANCY
2
Any period of incapacity
due to pregnancy, or for prenatal care.
4.
CHRONIC CONDITIONS REQUIRING TREATMENTS
A chronic condition that:
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; and
B. Continues over an extended period of time (including recurring episodes of a single underlying
condition); and
May cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy,
C.
etc.).
5.
PERMANENT/ LONG-TERM CONDITIONS REQUIRING SUPERVISION
2
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 disease, 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
2
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),
and kidney disease (dialysis).
3
Here and elsewhere on this form, the information sought relates only to the condition for which the employee is
requesting FMLA leave.
4
Incapacity, for the purposes of FMLA, is defined to mean the inability to work, attend school, or perform other regular
daily activities due to the serious health condition, treatment therefor, or recovery therefrom.
5
Treatment includes examinations to determine if a serious condition exists and evaluations of the condition.
Treatment does not include routine physical examinations, eye examinations, or dental examinations.
6
A regimen of continuing treatment includes, for example, a course of prescription medication (e.g., antibiotics) or
therapy requiring special equipment to resolve or alleviate the serious health condition. A regimen 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.
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