Washington Paid Family and Medical Leave covers the first six weeks of recovery after giving birth with a simple Certification of Birth. When recovery takes longer, or there were complications, the provider completes this form instead, describing the postnatal incapacity and the start and end dates of the medical leave. The patient uploads it to their Paid Leave account.
The patient completes Section 1 with name, date of birth and Paid Leave Customer ID; the treating obstetric or other health care provider completes and signs Section 2.
Download the current version from the source each time; forms change without notice.
Medical Certification for Birth Complications
Certificado médico por complicaciones en el parto
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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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When the birthing parent needs more than six weeks of medical leave to recover from giving birth, or had complications. If there were no complications and recovery leave is six weeks or less, the Certification of Birth is enough.
No. ESD's instructions for health care providers state that providers cannot charge a fee for completing the form. They also ask that the completed form be returned to the patient within 7 calendar days of receiving it.
Yes. ESD accepts an FMLA certification, such as a WH-380, or a provider note, as long as it contains the information required by WAC 192-610-020. The provider still signs, and the patient uploads it to their Paid Leave account.