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Colorado FAMLI Neonatal Admission Form

Since January 1, 2026, Colorado's FAMLI program has offered Neonatal Care Leave: up to 12 additional weeks for a parent whose newborn is admitted to a neonatal unit or a higher level of care. This form documents that admission. FAMLI lists it as one way to prove the stay, alongside proof from the hospital, and the parent attaches it to the claim.

Who completes it

It is completed by the admitting hospital or neonatal care team, although FAMLI's guidance does not name a required signer; the parent filing for Neonatal Care Leave uploads it.

Submitting and payment

How to submit it
The form is available inside the My FAMLI+ portal for Neonatal Care Leave claims rather than as a public download; the parent uploads the completed form to the claim.

Good to know

  • Neonatal Care Leave began January 1, 2026 and provides up to 12 extra weeks of leave for parents of a newborn in neonatal care.
  • Hospital proof of the neonatal admission can be submitted instead of this form, according to FAMLI's Neonatal Care Leave FAQ.
  • FAMLI's separate Serious Health Condition Form covers medical and family care leave certifications, which providers can complete online in My FAMLI+.

Get the official form

Download the current version from the source each time; forms change without notice.

FAMLI Neonatal Admission Form

Official page

Get the note ready with Vero

Colorado Department of Labor and Employment, Division of Family and Medical Leave Insurance (FAMLI) takes this form through its online services or your EMR, so there is no PDF to fill. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.

See how Vero Scribe works

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Where do I get the Colorado FAMLI Neonatal Admission Form?

It is found in the My FAMLI+ portal as part of a Neonatal Care Leave claim, not as a public PDF. FAMLI's Neonatal Care Leave FAQ names it as one way to document the newborn's admission to a neonatal unit or higher level of care; proof from the hospital is the alternative.

How much Neonatal Care Leave does Colorado FAMLI provide?

Up to 12 extra weeks of leave for a parent whose newborn is admitted to a neonatal unit or a higher level of care. The benefit started January 1, 2026, and the admission must be documented, with this form or hospital proof, in the parent's My FAMLI+ claim.