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Health-Care Provider Certificate

In order to qualify for leave based on a serious health condition, either your own or that of your spouse, child, or parent, you will need to provide ACST with a medical certification issued by a healthcare provider (generally your doctor) regarding the necessity of the leave.

You must provide the notice within 15 calendar days of your request for leave and it must be on a form provided by ACST. Failure to provide adequate medical certification may result in either the delay or denial of the requested leave.

If ACST has a question about the medical certification you have presented, it may request that you allow it to contact your health care provider to obtain a clarification or authentication of the medical certification. If you decline to allow ACST to contact your healthcare provide or if ACST continues to have a question about the medical certification you have presented, it may require you to obtain a second opinion at its expense from a healthcare provider of its choice. If the opinion of your healthcare provider differs from the healthcare provider selected by ACST, you may be required to obtain a third opinion, again, at the company’s expense. The third opinion will be binding, and you and ACST will jointly select the healthcare giver who is to provide it.

Re-certification of the continued medical necessity of the leave shall be provided every 30 days, unless you are instructed by ACST to furnish such certification more or less frequently. Some conditions are so serious that no additional certification of need for leave will be necessary. The form to be utilized is the same one used for your

initial medical certification. It is possible that ACST may ask you at other times to obtain a re-certification if it appears that your circumstances have changed significantly, you request additional leave, or information is received that casts doubt about the continuing validity of the certification.

If you take FMLA leave based upon your own serious health condition ACST may require you to provide written verification from your healthcare provider of your ability to resume work. This verification need only address the serious medical condition that prompted your leave. Failure to provide the requested fitness for duty slip will result in a delay or denial of your return to work.