Health care and service providers

What you need to know

Your role as a health care provider working with Paid Leave is important. We encourage employees who are experiencing a serious health condition or who provide care for a family member with a serious health condition to apply for Paid Leave benefits.

As a provider, when someone in your care is eligible for Paid Leave, you might receive a request from them or their family member to complete a Serious Health Condition Verification Form. Employees must provide this documentation when they send their application for benefits.

Your role with your patients

• Determine if your patient’s condition qualifies as a serious health condition and how much time they need to care for themselves or a family member. The length of time should be based on the medical need.
• Help your patient or their family verify a serious health condition. If your patient or their family member asks you to fill out a verification form, please return it to your patient as soon as possible.

Employees can use any of the following forms of verification:

• Paid Leave Oregon Verification of Serious Health Condition Form
• Oregon and Federal Family and Medical Leave Health Care Provider Certification 
• Certification of Health Care Provider for Employee’s Serious Health Condition under the Family and Medical Leave Act (FMLA)
• Employer-issued FMLA certification for a serious health condition 
• Other documentation from a health care provider that includes the following:
  • The claimant’s name
  • The claimant’s date of birth
  • The patient’s name and contact information (if applying for family leave)
  • A short description or diagnosis, including symptoms or required treatment of the serious health condition
  • The approximate date the serious health condition began or the date the serious health condition created the need for leave
  • The expected end date or an explanation that the condition is chronic or permanent.
  • For intermittent leave, an explanation of how often, and for how long, the condition impacts the patient.
  • The health care provider’s:
    • First and last name
    • Type of medical practice or specialty
    • Contact information such as business name, address, and phone number
    • Handwritten or electronic signatures from the health care provider and the date the documentation was signed

Important: If you issue any of these documents before the claimant starts leave, you must sign them within 60 days before the start of the leave. We encourage you to have copies of the forms available for your patients and their family members.

What you need to know

Service providers like social workers, police officers, Title IX coordinators, victim service providers, and people who work in adoption agencies or foster care organizations are important to the success of Paid Leave Oregon.

Your role

As a service provider, you can support those you serve as they apply for Paid Leave benefits. Employees who are eligible to apply for Paid Leave benefits include: 

• Survivors or parents of survivors of sexual assault, domestic violence, harassment, bias crimes or stalking
• Parents, including foster or adoptive parents, want time to bond with their child during the first year after birth, adoption, or foster care placement
• Parents completing necessary activities before adopting a child or having a foster care child join their home

When an employee applies for Paid Leave, they may need to show documentation that verifies their need for leave. As a service provider, you can help them fill out the forms or gather other documents for their Paid Leave application for benefits.