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Health care provider responsibilities for paid family and medical leave

Health care providers are a critical part of maintaining the integrity of Massachusetts’ paid family and medical leave program.

Table of Contents

Overview

Health care providers are a critical part of maintaining the integrity of the Massachusetts’ paid family and medical leave program. 

As a health care provider, you play an important role in Massachusetts’ paid family and medical leave application process. We rely on the information you provide to approve or deny paid leave applications. 

Download a Medical Provider Toolkit for more information.

You may need to fill out the Certification of your Serious Health Condition form when your patient needs medical leave from their job due to the patient’s serious health condition. You may also need to fill out the Certification of your Family Member’s Serious Health Condition form when your patient’s family member needs to take leave to care for your patient.

Medical Leave

The Certification of your Serious Health Condition form is a required form for your patient’s application for medical leave for their own serious health condition. The Department of Family and Medical Leave will use the information on this form to approve or deny applications for paid leave benefits.

A patient’s Certification of your Serious Health Condition form should contain relevant information about the serious health condition incapacitating your patient from work,  including but not limited to: 

  • A statement that your patient has a serious health condition incapacitating your patient from work (Questions 8-10). This is the reason for your patient’s leave so make sure to discuss their condition with them.

  • The date on which your patient’s serious health condition started (Form Question 11). 

  • The probable duration of your patient’s serious health condition (Form Questions 14-16, Part 3A).

  • A certification that your patient can’t work due to their serious health condition (Form Question 23).

  • The probable duration of your patient’s serious health condition (Form Questions 17-19 and/or 20-22, Part 3B and C) 

Your patients should bring a copy of the Certification of your Serious Health Condition form with them for you to fill out during their regularly scheduled appointment if they are planning on applying to take paid medical leave. It will be their responsibility to submit the completed form to the Department as a part of their application. 

Family Caring Leave

The Certification of your Family Member’s Serious Health Condition form is what employees submit as part of their application for family leave to care for a family member with a serious health condition. You will receive this form when your patient has a serious health condition that requires care from a family member, and that family member needs time off of work to provide that care. The family member may not be your patient, but they will need the certification from you to show their need for leave to care for your patient. The Department of Family and Medical Leave will use the information on this form to approve or deny applications for paid leave benefits.

A patient’s Certification of your Family Member’s Serious Health Condition form should contain relevant information about their family member’s serious health condition that is causing the employee to take leave to care for them. It should include but not be limited to:

  • A statement that your patient, the employee’s family member, has a serious health condition and any other relevant details about your patient's condition (Form Questions 14-15, 18) This is the reason for an employee to take leave to care for your patient.

  • The date on which your patient’s serious health condition started (Form Question 16) 

  • That your patient needs care from their family member and what kinds of care might be needed (Form Question 19-20)

  • Information about how often and how long your patient needs the family member to care for them (Form Questions 21-29)

Your patient (possibly accompanied by the patient’s family member) should bring a copy of the Certification of your Family Member’s Serious Health Condition form with them for you to fill out. It will be the family member’s responsibility to submit the completed form to the Department as a part of their application. 

Contact

Phone

For questions about benefits and eligibility: (833) 344-7365

Department of Family and Medical Leave - Hours of operation: Monday-Friday, 8 a.m - 5 p.m.

Fraud Reporting Hotline: (857) 366-7201

Department of Family and Medical Leave - Hours of operation: Monday-Friday, 8 a.m - 5 p.m.

For questions about contributions and exemptions: (617) 466-3950

Department of Revenue - Hours of operation: Monday-Friday, 8:30 a.m. - 4:30 p.m.

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