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SECTION II: INSTRUCTIONS to the HEALTH CARE PROVIDER: Your patient has requested leave. Answer fully and completely, all
applicable parts. Several questions seek a response as to the frequency or duration of a condition, treatment, etc. Your answer should be your best
estimate based upon your medical knowledge,…
https://www.wichita.edu/services/humanresources/Total_Rewards/Leave/Shared_Leave/CHCP_Employee_Non-FMLA.pdf