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  2. Forms Repository
  3. ERD-10111-E, Physician or Practitioner Certification for Family or Medical Leave

Physician or Practitioner Certification for Family or Medical Leave

Document Number: ERD-10111-E

Description: This form should be used by employers to assist in establishing leave entitlement under Wisconsin's Family and Medical Leave Law.

Comments: This form may be reproduced by employers.

Content Contact: Equal Rights Information

Document Attachments:

ERD-10111-E (English Electronic Version - Word/68 KB)

ERD-10111 (English Print Version - pdf/18 KB)

ERD-10111-S (Spanish Print Version - pdf/82 KB)

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.

Contact Information

For questions about this form, or if you need this form in an alternate format, please see the Content Contact (listed to the left)

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