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Paid Family and Medical Leave documents and forms for health care providers

Information and forms for Massachusetts health care providers to help them inform patients about the PFML law.
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Health care provider toolkit

Open PDF file, 3.27 MB,  Health Care Provider Toolkit for Paid Family and Medical Leave (English, PDF 3.27 MB)

Health care provider forms

Open PDF file, 995.89 KB,  Certification of your Serious Health Condition form (English, PDF 995.89 KB)
Open PDF file, 1.31 MB,  Certification of your Family Member's Serious Health Condition form (English, PDF 1.31 MB)

Contact

Phone

Get answers to your questions in English, Español, and Português. Interpretation services for up to 240+ languages are also available. (833) 344-7365

Department of Family and Medical Leave - Hours of operation: Monday-Friday, 8 a.m. - 4:30 p.m.

Fraud Reporting Hotline: (857) 366-7201

Department of Family and Medical Leave - Hours of operation: Monday-Friday, 8 a.m. - 4:30 p.m.

For questions about contributions: (617) 466-3950

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

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