Leave of Absence (LOA) Information

Below you will find information and resources for Leave of Absences (LOAs).

The following are resources for all employees: LOA Policy, State Packets, Request Form and Return to Work Form.
Hospital leaders should follow the LOA Process outlined below when an employee notifies them of a need for a leave of absence.

LOA Policy

This policy ensures a consistent and efficient process for employees who need to take a leave of absence in compliance with federal and state laws. It is intended to help ease the process of taking a leave of absence during an employee’s time of need; understanding their options and rights.

WHO:

All employees

WHAT:

Time off requests for medical, maternity, military, extended personal leaves, etc.
Dependent upon state and federal laws.
See the Request Form for definitions of leave types.
Please refer to your State LOA Informational Packet below for further information on LOAs and eligibility.
Other than leaves required by law, a leave of absence is a privilege, not a right, and is granted at the discretion of management.

State LOA Informational Packets

Request Form

Leave of Absence (LOA) Request Form.pdf (fillable PDF form)

Return to Work Authorization Form

Return to Work Authorization Form (RTWF)

LOA Process

This process is intended to provide Practice Managers and Principal Doctors instructions on an employee Leave of Absence (LOA). Please direct all questions, request forms and paperwork to HR@wellhaven.com and your Human Resource Business Partner will follow up.

HOW:

When an employee notifies their PM or Principal Doctor of their need for a Leave of Absence, please provide the employee with the WH Leave of Absence (LOA) Request Form. The employee will need to complete the form, scan and email to HR at the email listed above.
Once the PM or Principal Doctor receives the signed approval from HR, they will need to coordinate with their hospital team to accommodate the approved time off.
LOA forms are to be kept separate from the employee file and kept secure to comply with legal requirements.
If an employee has questions regarding the time off, or their situation is of a sensitive nature, please direct the employee to HR at the email above at HR@wellhaven.com.

LOA Policy

Request Form

Return to Work Authorization Form

LOA Process

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