Minnesota Paid Leave needs this certification when a worker applies for medical leave for their own serious health condition. The treating provider checks which serious health condition criteria apply, estimates when the condition started and how long it will last, confirms the job duties the patient cannot do, and sets out continuous, reduced-schedule or intermittent leave. Paid Leave verifies the certifier before deciding the claim.
The applicant completes Section 1, including the physical or cognitive job duties they cannot do, and signs. The treating healthcare provider completes Section 2 (health condition), Section 3 (leave information) and Section 4 (provider certification) and returns the form to the patient.
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Minnesota Paid Leave Medical Leave Certification Form
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Yes, if it includes all the required information. Minnesota Paid Leave accepts FMLA certification forms that are complete and considers employer-developed forms case by case, but it recommends its own forms. Because Paid Leave covers more situations than FMLA, some leave that qualifies for Paid Leave may not qualify for FMLA.
A provider licensed, certified or otherwise authorized to certify the condition within their scope of practice. The form lists physicians, physician assistants, nurse practitioners, nurse-midwives, licensed midwives, dentists, optometrists, podiatrists, clinical psychologists, clinical social workers, Minnesota-defined mental health professionals and alcohol and drug counselors, and chiropractors for limited spinal treatment.
That the patient is receiving care for a serious health condition and cannot perform regular work because of the condition or its treatment, that the answers are true and complete, and that the provider is authorized to certify the condition. The provider also states whether the condition is a job-related injury.