AMOUNT OF LEAVE NEEDED Sample Clauses

AMOUNT OF LEAVE NEEDED. 5. Will the employee be incapacitated for a single continuous period of time due to his/her medical condition, including any time for treatment and recovery? No Yes If so, estimate the beginning and ending dates for the period of incapacity:
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AMOUNT OF LEAVE NEEDED. Please estimate the beginning and ending dates for the period of incapacity:
AMOUNT OF LEAVE NEEDED. For the medical condition(s) checked in Part A, complete all that apply. Several questions seek a response as to the frequency or duration of a condition, treatment, etc. Your answer should be your best estimate based upon your medical knowledge, experience, and examination of the patient. Be as specific as you can; terms such as “lifetime,” “unknown,” or “indeterminate” may not be sufficient to determine FMLA coverage.
AMOUNT OF LEAVE NEEDED. Will the employee be incapacitated for a single continuous period of time due to his/her medical condition, Including any time for treatment and recovery? ___No ___ Yes If so, estimate the beginning and ending dates for the period of incapacity: _________________________ Will the employee need to attend follow-up treatment appointments or work part-time or on a reduced schedule because of the employee’s medical condition? ___ No ___ Yes If so, are the treatments or the reduced number of hours of work medically necessary? ___ No ___ Yes Estimate treatment schedule, if any, including the dates of any scheduled appointments and the time required for each appointment, including any recovery period: ______________________________________________________________________________________ Estimate the part-time or reduced work schedule the employee needs, if any: _____ hour(s) per day; _____ days per week from _________________ through _____________________ Will the condition cause episodic flare-ups periodically preventing the employee from performing his/her job functions? ___ No ___ Yes Is it medically necessary for the employee to be absent from work during the flare-ups? ___ No ___ Yes. If so, explain: _______________________________________________________________________________ _______________________________________________________________________________ Based upon the patient’s medical history and your knowledge of the medical condition, estimate the frequency of flare-ups and the duration of related incapacity that the patient may have over the next 6 months (e.g., 1 episode every 3 months lasting 1-2 days): Frequency: _____ times per _____ week(s) _____ month(s) Duration: _____ hours or _____ day(s) per episode ADDITIONAL INFORMATION: IDENTIFY QUESTION NUMBER WITH YOUR ADDITIONAL ANSWER: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ____________________________________________________________________...

Related to AMOUNT OF LEAVE NEEDED

  • Amount of Leave Bereavement leave shall not exceed three (3) workdays for the death of a member of the employee's immediate family. Also, an employee shall be entitled to use two (2) days of sick leave as bereavement leave.

  • Period of Leave (a) The period of leave will be for 12 months, from 1 January to 31 December.

  • Annual Leave Loading (a) In addition to their ordinary pay, an employee, other than a shiftworker, will be paid an annual leave loading of 17.5% of their ordinary pay on a maximum of 152 hours/four weeks annual leave per annum.

  • Taking of Leave (a) Annual leave shall be given and shall be taken within a period of six months after the date when the right to annual leave accrued; provided that the giving and taking of such leave may be postponed by mutual agreement between the parties for a further period not exceeding six months.

  • Commencement of Leave Parental leave must commence no later than the first anniversary date of the birth or adoption of the child or of the date on which the child comes into the actual care and custody of the employee. The employee will decide when his or her parental leave is to commence.

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