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Employee & Labor Relations

A Resource for County of San Mateo Employees, Supervisors, and Managers

D.02 What should be included on the medical certification form from the doctor?

Employee Relations Handbook, Leave of Absence

For an employee’s own illness:

  • The date on which the serious health condition commenced;
  • The probable duration of the condition;
  • That the employee is unable to perform the functions of his or her position.

For a family member’s illness:

  • The date on which the serious health condition commenced;
  • The probable duration of the condition;
  • An estimate of the amount of time the employee needs to care for the family member;
  • Verification that the serious health condition warrants the participation of the employee to provide care during the period of treatment.