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FMLA: For Employees

Last Modified: 2016-12-21

FMLA Process map

Below are some resources to assist you as you move through the FMLA application process. If you have questions about the FMLA process, you may contact your FMLA Coordinator at 343-4125 or email

Also see these webpages with information for birth of a child:


Step 1: FMLA Request and Receive Eligibility Determination

You  may complete the online Medical Leave Request form to request FMLA or Non-FMLA leave.

Step 2: Complete Medical Certification Form 

The FMLA coordinator will provide this form upon submission of your FMLA request and eligibility determination. This form must be submitted to Human Resources.

Step 3: FMLA Approval or Denial

The FMLA Coordinator will provide your leave approval letter and additional materials upon completion of steps 1 and 2 above. 

If you are a privileged provider or hold clinical privileges, Provider Support Services (PSS) must be notified of your FMLA approval.  Please send an email to with your full name and dates of absence once you have received your approval letter.

Step 4: While on FMLA

Step 5: Returning from FMLA