Leave of Absence (LOA) Information

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

LOA processing partner - FMLASource
Contact FMLASource for all your LOA Requests
- Email: FMLACenter@fmlasource.com
- Phone: 1-877-GO2.FMLA (1-877-462-3652)
- Website: www.fmlasource.com
- Mobile App: download FMLASource Now (for GooglePlay or Apple iOS)

Listed below are resources for all employees: LOA Policy and State Packets
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.
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

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 employees to request their Leave of Absence with FMLASource WellHaven’s LOA processing partner. For questions related to LOA’s or job accommodations please reach out to HR@wellhaven.com.

HOW:

When an employee notifies their PM or Principal Doctor of their need for a Leave of Absence, please provide the employee with the contact information for FMLASource as listed above.
Once the PM or Principal Doctor receives the LOA approval from FMLASource they will need to coordinate with their hospital team to accommodate the approved time off for an LOA.
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

Return to Work Authorization Form

LOA Process

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