The CalHR 754 is the official medical certification used by California state employees to request protected leave under the Family and Medical Leave Act (FMLA) and the California Family Rights Act (CFRA). A licensed healthcare provider must complete Parts C and D, documenting the serious health condition of the employee or their family member, including specific diagnosis information and the expected recovery timeline. Federal law and California state regulations require this certification before the department administrator (Part A) can approve medical leave requests. Part B is completed by the employee seeking leave, while Part E details the total medical absence time required. After the healthcare provider returns the completed certification, your department reviews the documentation and approves specific leave arrangements. You can also view the related CalHR 774 certification or the FMLA leave form for similar medical leave documentation.
| Question | Answer |
|---|---|
| Form Name | Calhr 754 Form |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | calhr 752, calhr for 695 open enrollment form, calhr form printable, calhr form 1094 |