Certification of Health Care Provider for Employee’s Serious Health Condition (Family Medical Leave Act) Employee Number: Part A For Completion by the Employee: Name: Department:

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Date: 2013-03-28 10:50:20		Certification of Health Care Provider for Employee’s Serious Health Condition (Family Medical Leave Act) Employee Number: Part A For Completion by the Employee: Name: Department: Add to Reading List Source URL: bhr.sd.gov Download Document from Source Website File Size: 230,83 KB Share Document on Facebook