- Grants up to 12 weeks leave in a 12-month period
- Leave Granted for one or more of the following reasons
- Birth of a child and care after such birth for either parent
- Placement of child for adoption or foster care for either parent
- Serious health condition of spouse, child or parent of employee
- Serious health condition of employee(unable to perform job)
- UTHealth Handbook of Operating Procedures FMLA Policy
Sick and Vacation Leave
- Employees must exhaust all sick leave and vacation leave, if applicable, when taking FMLA
- Paid leave counts against the 12-week FMLA entitlement
- UTHealth continues to contribute its share of premium sharing for insurance at the department’s expense
- 30 days or as soon as practical
- Verbal notice is sufficient
- Department may require certification from the health care provider
Request for Family Medical Leave – to be completed by employee and returned to residency coordinator.
Certification of Health Care Provider – Resident/Fellow – to be completed by health care provider & resident and returned to coordinator.
Certification of Health Care Provider – Family Member – to be completed by health care provider & resident and returned to coordinator.
Certification of Health Care Provider – Family Member with Military Injury – to be completed by health care provider & resident and returned.
Certification of Qualifying Urgency for Military Family Medical Leave – to be completed by the resident and returned with the above form.
Acknowledgement & Approval Form for Family Medical Leave – Completed by Program Director within 5 days of request submission.
Certification of Fitness for Duty – to be completed by health care provider and returned
Time Log – to be maintained by residency program timekeeper.
FMLA Sample Letters
(Download Word Documents – may be edited to fit specific situations.)
FMLA Certification Request Letter – Letter from supervisor to employee requesting completion of the Certification of Health Care Provider Form.
FMLA First Letter for Illness – Letter from supervisor to employee regarding FMLA.
FMLA First Letter for childbirth – Letter from supervisor to employee regarding FMLA available for pregnancy leave.
FMLA Middle Letter -Follow-up FMLA letter from supervisor to employee.
FMLA Extension Letter -Letter from supervisor to employee regarding FLMA expiration and options available if additional time is needed.
Human Resources Advising Team
Updated 12/12/2019 ascambel