Get Allegheny Health Network Human Resources

This guide provides a comprehensive overview of how to accurately fill out the Allegheny Health Network Human Resources medical certification form for an employee's serious health condition. Follow the steps outlined below to ensure that all necessary information is completed correctly.

Follow the steps to fill out the medical certification form.

1. Click ‘Get Form’ button to obtain the medical certification form, ensuring it's opened in the appropriate editor.
2. Begin filling out the employee's information, including their name, employee number, and contact details. Complete the section regarding the health care provider or case worker's qualifications by entering their printed name and signature.
3. Indicate the reason for leave by checking all applicable conditions that match the employee's medical situation. For each condition listed, provide the necessary details, including treatment dates.
4. Specify whether the leave will be continuous or intermittent, including start and end dates. If intermittent, estimate the treatment schedule and the expected frequency and duration of episodes of incapacity.
5. In the work limitations section, identify if the employee is unable to perform specific job functions due to their condition and state whether the health condition is permanent or requires additional evaluations.
6. Finish by having the healthcare provider or case worker sign the form, entering their credentials, and providing their contact information, including phone and fax numbers.

Complete the medical certification form online to support the employee's health needs efficiently.