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Family Medical Leave Act (FMLA)

Under federal law, most employers must grant an eligible employee up to a total of 12 work weeks of unpaid leave during any 12-month period for one or more of the following reasons:

To care for an immediate family member (spouse, child, or parent) with a serious health condition; or
To take medical leave when the employee is unable to work because of a serious health condition.

Our office will need:

A completed Authorization for Disclosure Form
A completed Disability Claim Form
A completed FMLA packet from your employer’s HR department (or contact us if you are unable to get FMLA forms from your employer)

(see FORMS in the right column)

You may either mail or fax the completed forms to our office:

Kaiser Permanente Medical Secretary Department
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