Family and Medical Leave Act (FMLA)
The Family and Medical Leave Act (FMLA) entitles employees to take unpaid time off work for a total of up to 12 weeks for their own serious health condition or a family member's serious health condition. FMLA defines "a serious health condition" as any illness, injury, impairment, or physical or mental condition that involves either inpatient care or continuing treatment by a health care provider. To learn more about FMLA, go to the federal FMLA site.
Because some applications for family and medical leave require medical certification, Kaiser Permanente has implemented a standardized FMLA process to organize and streamline the review and provider certification of your FMLA forms. Please note, additional appointments may be required if the patient has not had a recent visit for the condition listed.
Our FMLA process is now done electronically through your online health record. The patient or family member requesting FMLA certification will receive a signed, system-generated federal FMLA form either in person, by fax, or directly from the secure member site.
How to submit paperwork
- Download and fill out our FMLA intake form for your own condition (PDF) or to care for your family member (PDF); we do not accept employer FMLA forms. Please note, the patient must be receiving care from a Kaiser Permanente clinician.
- If you would like to have the paperwork mailed, faxed, or picked up by a third party, you will need to complete a Release of information form (PDF).
- Print and submit the completed form(s) to your Kaiser Permanente clinic in person or by fax. Find a location near you.
FMLA requests can take up to 10 business days to process. Delays in paperwork can occur if sections of the FMLA intake form are missing or incomplete, the required number of visits for the condition listed has not been met, or the number of available days off has been exhausted.
If you have questions, please contact the business office at the clinic in which you are being seen for the condition listed.
Note: Your employer's human resources team and/or third-party processing company is responsible for ultimate approval or rejection of your FMLA request. Kaiser Permanente provides a clinical review of your request, provider's signature, and release of FMLA form only.