CHECKLIST How to Identify a Serious Health Condition under FMLA

Leave may be available under the Family and Medical Leave Act of 1993 when a serious health condition exists. Such a condition exists if an employee, or the employee’s child, spouse, or parent has an illness, injury, impairment, or physical or mental condition that involves either (1) inpatient care, or (2) continuing treatment by a health care provider. Use the following guidelines to determine whether an absence can be attributed to a serious health condition.

INPATIENT CARE (check one)

• 1A. Overnight stay in a hospital, hospice, or residential medical care facility.

• 1B. Any period of incapacity or subsequent treatment in connection with an overnight stay in the type of facility listed above.

CONTINUING TREATMENT (check at least one)

• 1A. Incapacity lasting more than 3 consecutive calendar days and that involves: (to check this, you must first check one of the following)

• a. Two or more treatments by or under the supervision, orders, or referral of a health care provider or

• b. One treatment by a health care provider followed by a regimen of continuing treatment under the supervision of the health care provider (e.g., prescription medications or therapy with specialized equipment but not over-the-counter medications or salves, bed- rest, fluid intake or exercise).

• 1B. Any period of incapacity or subsequent treatment relating to the above condition.

• 2. Incapacity due to pregnancy or for prenatal care.

• 3. Incapacity or treatment for a chronic serious health condition that: (to check this, you must first check all of the following)

• a. Requires periodic visits for treatment by or under the direct supervision of a health care provider and

• b. Continues over an extended period (including recurring episodes) and

• c. May be episodic (e.g. asthma, diabetes, epilepsy).

• 4. Permanent or long term incapacity for which treatment may be ineffective and which requires the supervision of, but not necessarily treatment by, a health care provider (e.g. Alzheimer’s, severe stroke, terminal stages of disease).

• 5A. Absences to receive multiple treatments by or under the supervision, orders, or referral of a health care provider for: (to check this box, you must first check one of the following)

• a. Restorative surgery after an accident or injury or

• b. A condition that is likely to result in incapacity of more than 3 consecutive calendar days without medical intervention or treatment (e.g. cancer, severe arthritis, kidney disease).

• 5B. Any period of recovery relating to the above treatments.

Cite: 29 CFR §825.114.

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