DCH Health System
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Tools & Forms

Employee Hospital Leave
Application for Employee Hospital Leave

Certification of Health Care Provider

Hospital Medical Leave Acknowledgement Form

Return to Work Form

Employee Medical Leave
Application for Employee Medical Leave

Certification of Health Care Provider

Return to Work Form

Employee Rights & Responsibilities

Family Member Hospital Leave
Application for Family Medical/Hospital Leave

Certification of Health Care Provider

Hospital Medical Leave Acknowledgement Form

Family Member Medical Leave
Application for Family Medical Leave

Certification of Health Care Provider

Employee Rights & Responsibilities

Military Leave
Request for Military Leave

Certification of Health Care Provider

Employee Rights and Responsibilities

 




Leave Requests/FMLA
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