Dear Valued Patient,
We understand that navigating the Family and Medical Leave Act (FMLA) process can be complex. To assist you, we offer FMLA form completion services for your convenience.

Our FMLA Form Completion Service
Our experienced providers can complete the necessary FMLA forms on your behalf for a fee of $25.00. This fee covers the time and expertise required to ensure your forms are accurately and thoroughly completed.

Payment and Refund Policy
The $25.00 fee is due at the time you drop off your FMLA forms at our office. In the unlikely event that our providers are unable to complete your forms due to unforeseen circumstances, you will receive a full refund of the fee.

Processing Time
Please allow three business days for our team to complete your FMLA forms. We strive to provide efficient and timely service to meet your needs.

There are several reasons why a provider might not be able to complete an FMLA form for a patient:

1. Insufficient Medical Information: If the patient's medical records do not adequately support the need for FMLA leave, the provider may not be able to certify the form. This could be due to a lack of documentation of a serious health condition, insufficient details about the condition, or unclear information about the need for leave.
2. Incomplete Patient Information: The FMLA form requires specific details about the patient's job and employer. If this information is missing or inaccurate, the provider cannot complete the form.
3. Ethical or Legal Concerns: If the provider has concerns about the legitimacy of the patient's request or believes that the information provided is fraudulent, they may decline to complete the form due to ethical or legal obligations.
4. Provider's Scope of Practice: In some cases, the required medical certification may fall outside the scope of practice of the specific provider at RDV Sportsplex Pediatrics. For example, a pediatrician may not be qualified to certify an FMLA form for a complex adult medical condition.
5. Conflict of Interest: If the provider has a personal or professional relationship with the patient's employer, they may be unable to complete the form due to a conflict of interest.
6. Administrative Issues: In rare cases, there may be administrative issues, such as missing pages from the form or incorrect versions of the form, that prevent the provider from completing it.
In any of these situations, the provider will inform the patient and, if applicable, refund the processing fee.