Employee's Certification of Health Care Provider

This form is to be completed by your physician and submitted within 15 calendar days of your leave request form.  Your physician should fax the fully completed form to (313) 748-6119.  Leaves cannot be approved until a complete and sufficient Certification of Health Care Provider form has been received and reviewed.

WH-380-E.pdf, 497.59 KB; (Last Modified on July 8, 2019)