For Family Members

Documents and forms under this section (FML for Family Member Condition) are for an employee who has a spouse, dependent child, parent or domestic parent that has a serious health condition under the FMLA.

This section contains the necessary forms needed to complete your Leave of Absence process.

  • Disregard any documents that have already been submitted or do not apply to your situation.
  • LOA request form is due back to Benefits as soon as possible with employee and supervisory signatures.
  • Certification of Health Care Provider is due back to the Denver Health Employee Benefits Department within 21 days after you have submitted a Request for LOA.

1 LOA Form-Instructions
2 Certification of Health Care Provider Family
3 FMLA Leave Codes
5 FMLA Poster 2009
6 Definitions Under the FMLA
7 FMLA Eligibility Checklist