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Paid Leave Oregon Verification of Birth (PL Form 810)

Paid Leave Oregon claimants use PL Form 810 to verify a child's birth or expected birth for family leave to bond during the child's first year. A parent who gave birth also uses it to request two extra weeks of family leave. The provider confirms the birth date or due date in Parts B and C, and the claimant sends it with the application.

Who completes it

The claimant completes Part A; an authorized health care provider of the child or of the parent who gave birth completes Part B (child and birth details) and Part C (provider information and signature).

Submitting and payment

How to submit it
The provider returns the signed form to the claimant, who uploads it to Frances Online or mails it to Paid Leave Oregon; it must be signed no earlier than 60 days before the expected birth and no later than one year after.
Who pays
The form sets no fee and names no payer for completing it.

Good to know

  • Forms with strikeouts, whiteout or any change after signing are rejected; after an error, start a new copy from Paid Leave Oregon's Resources page.
  • Part B accepts an expected delivery date, so the form can be completed before the birth, inside the 60-day window.
  • By signing Part C the provider declares they meet the OAR 471-070-1000 definition, which includes physicians, nurse practitioners, nurse-midwives, direct entry midwives, registered nurses and others.
  • A birth certificate is an alternative proof for bonding leave, so the form is optional. Spanish and other language versions are posted.

Get the official form

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

Verification of Birth Form

Formulario de verificación de nacimiento

Official pagePDFVersión en español

Fill it with Vero

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.

See how Vero Documents 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

When can Paid Leave Oregon's PL Form 810 be signed?

Both the claimant and the provider must sign no more than 60 days before the child's expected birth date and no more than one year after the birth. Paid Leave Oregon does not accept Verification of Birth forms signed outside that window.

Is a birth certificate accepted instead of the Verification of Birth form?

Yes. A birth certificate is an alternative proof of birth for bonding leave, which makes PL Form 810 optional. The provider form is most useful before the birth or when the certificate is not yet available.

Are electronic signatures accepted on PL Form 810?

Yes. Paid Leave Oregon accepts handwritten or electronic signatures. It will not accept a form altered after signing, including strikeouts or whiteout, or one signed outside the window of 60 days before the expected birth to one year after.