Item #: 2548983 | Model #: A1424
ComplyRight FMLA Family Member Medical Certification Form, Pack of 50 (A1424)
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ComplyRight FMLA Family Member Medical Certification Form, Pack of 50 (A1424)

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Product Details
  • Attorney-developed to ensure 100% compliance
  • Form meets all FMLA required elements for Notice of Privacy Practices
  • Size: 17" x 11" folded to 8 1/2" x 11"
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44.99
44.99
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00015171383074
ComplyRight
ComplyRight FMLA Family Member Medical Certification Form, Pack of 50 (A1424)
Product Description
Maintain your FMLA readiness with the ComplyRight FMLA Family Member Medical Certification Form

The ComplyRight FMLA Family Member Medical Certification Form allows healthcare providers to verify a family member's health condition to support a request for FMLA leave to care for a family member such as parent, child or next of kin, and is an integral part of your ComplyRight FMLA Administration System.

  • Attorney-developed to ensure 100% compliance
  • Form meets all FMLA required elements for Notice of Privacy Practices
  • Size: 17" x 11" folded to 8 1/2" x 11"
  • Package of 50 forms
Specifications
HR Form Type Medical Records Folders
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