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Priority Number

FMLA Family Member Medical Certification Form

A1424

Don't run out of medical forms you need to manage FMLA

Maintain your FMLA readiness with the ComplyRight FMLA Medical Certification - Family Member form. The 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.

$49.99

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Product Specifications:

  • Size: 17” x 11” folded to 8 ½” x 11”
  • Sold in packs of 50