FMLA Forms, GINA Doctor Notice, Release to Talk to Doctor

In February 2013, the DOL updated its model FMLA forms and notice poster, amending the forms' expiration dates to February 28, 2015 but offering little in the way of substantive revisions (despite recent rulemaking on military caregiver leave provisions). Links to the agency's revised forms and poster are below:

In 2010 the Equal Employment Opportunity Commission released a regulation pertaining to the Genetic Information Nondiscrimination Act (GINA) which said that employers should provide a notice to health care professionals regarding nondisclosure of genetic information during medical information related requests. While a FMLA and ADA exceptions exist, they are narrow and employers may still want to give a GINA notice.

Sample GINA Notice

(GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. "Genetic information" as defined by GINA, includes an individual's family medical history, the results of an individual's or family member's genetic tests, the fact that an individual or an individual's family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual's family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.

Other Resources

Employers with Fewer than 50 Employees

While the federal Family and Medical Leave Act generally applies to employers with 50 or more employees (within a 75-mile radius), the federal GINA law applies to employers with 15 or more employees. Thus, if your firm is dealing with issues of workers compensation, ADA reasonable accommodation, sick leave (e.g., request for doctor's note), FMLA compliance in states that have lower employee-count thresholds (see below), or just by policy allow medical/family leave, you still must use the appropriate GINA notice with communicating with doctors. The following notices can use used with correspondence or even read over the phone.

Cases of an Employee's Serious Health Condition

The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. `Genetic information' as defined by GINA, includes an individual's family medical history, the results of an individual's or family member's genetic tests, the fact that an individual or an individual's family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual's family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.

Cases of an Employee Family Member's Serious Health Condition

The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. "Genetic Information" as defined by GINA includes the results of an individual's or family member's genetic tests, the fact that an individual or an individual's family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual's family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services. Please provide medical history information regarding your patient only to the extent necessary to fully respond to all relevant items below.

Release for Employer to Speak to Employee's Docto

HIPPA makes it very difficult for employers to speak to an employee's doctor about a specific medical issues. However, when trying to reasonably accommodate an employee's job modification/task request sometimes it is necessary for the employer to obtain more information.  In such cases a Medical Authorization Form For Use and Disclosure of Protected Health Information is necessary. This release was provided by the lawfirm of Ogletree Deakins, et al.

States with Family and Medical Leave Act Laws

Certain states have passed various versions of the Family and Medical Leave Act. Employers must review both the federal and state laws to ensure compliance with the stricter elements of each.

California. While the state's Family Rights Act applies to employers with 50 or more employees, the state's pregnancy leave law applies to 5 or more and the state's Victims of Domestic Violence Employment Leave applies to employers with 25 or more employees. California passed a paid sick leave law in 2015.

Connecticut. Connecticut's FMLA law applies to employers with 75 or more employees.

District of Columbia. The District of Columbia's FMLA law applies to employers with 20 or more employees.

Hawaii. Hawaii's FMLA law applies to employers with 100 or more employees. Hawaii's Victims Leave Act provides for leave up to 30 days for employers with 50 or more employees, and up to five days for employers with 49 or fewer employees.

Maine. Maine's FMLA law applies to employers with 25 or more employees. Maine's Employment Leave for Victims of Violence applies to all employers.

Minnesota. Minnesota's FMLA law applies to employers with 21 or more employees. Minnesota's Domestic Abuse law does not have an employer cut-off.

New Jersey. New Jersey's FMLA law applies to employers with 50 or more employees, but differs significantly from the federal law with a paid-leave element.

Oregon. Oregon's FMLA law applies to employers with 25 or more employees. Oregon's Leave for Victims of Domestic Violence law applies to employers with six or more employees.

Rhode Island. Rhode Island's FMLA law applies to employers with 50 or more employees but has different leave thresholds.

Vermont. Vermont's parental leave law applies to employers with 10 or more employees and family leave law applies to employers with 15 or more employees.

Washington. Washington's FMLA law applies to employers with 50 or more employees.

Wisconsin. Wisconsin's FMLA law applies to employers with 50 or more employees, but have variation in the leave requirements.