The State of Connecticut Human Resources Medical Certificate (Form P33A, revised February 2011) is used by employees to document a serious health condition or FMLA-qualifying absence. The attending physician or licensed practitioner must complete all required sections to certify the diagnosis, the expected duration of the employee's incapacity, and the recommended treatment plan.
Connecticut state employees must submit the completed medical certificate within 30 days of foreseeable leave. The form verifies that the employee's condition meets the FMLA definition of a serious health condition. It also complies with the Genetic Information Nondiscrimination Act (GINA), directing providers not to include genetic information in their responses.
Employees managing health-related leave may also need the FMLA leave form for federal qualifying absences, or the non-FMLA medical certification form when FMLA criteria are not met. The family leave eligibility form helps employees confirm their leave entitlements before completing a medical certificate.
| Question | Answer |
|---|---|
| Form Name | Cthr Medical Certificate Form |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | connecticut medical certificate, p33a, connecticut human leave, connecticut human leave make |