APPENDIX A

Guide for Serious Health Condition Determination



A "Serious Health Condition" means an illness, injury, impairment, or physical or mental condition that involves that one of the following:

1. Hospital Care

 Inpatient care (i.e., an overnight stay) in a hospital, hospice, or residential medical care facility, including any period of incapacity 1 or any subsequent treatment in connection with or consequent to such inpatient care.

2. Absence Plus Treatment

 (a) A period of incapacity of more than three consecutive calendar days (including any subsequent treatment or period of incapacity related to the same condition) that also involves:

 (1) Treatment 2 two or more times by a health care provider, by a nurse or physician's assistant under direct supervision of a health care provider, or by a provider of health care services (e.g., physical therapist) under orders of, or on referral by, a health care provider; or

 (2) Treatment by a health care provider on at least one occasion which results in a regimen of continuing treatment 3 under the supervision of a health care provider.

3. Pregnancy

 Any period of incapacity due to pregnancy, or for prenatal care.

4. Chronic Conditions Requiring Treatments

 A chronic condition which:

 (1) Requires periodic visits for treatment by a health care provider, or by a nurse or physician's assistant under the direct supervision of a health care provider;

 (2) Continues over an extended period of time (including recurring episodes of a single underlying condition); and

 (3) May cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy, etc).

5. Permanent/Long-term Conditions Requiring Supervision

 A period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective. The employee or family member must be under the continuing supervision of, but need not be receiving active treatment by, a health care provider. Examples include Alzheimer's, a severe stroke, or the terminal stages of a disease.

6. Multiple Treatments (Non-Chronic Conditions)

 Any period of absence to receive multiple treatments (including any period of recovery therefrom) by a health care provider or by a provider of health care services under orders of, or on referral by, a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity1 of more than three consecutive calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc), severe arthritis (physical therapy), and kidney disease (dialysis).


1 Incapacity is defined to mean inability to work, attend school or perform other regular daily activities due to serious health condition, treatment therefor, or recovery therefrom.

2 Treatment includes examinations to determine if a serious health condition exists and evaluations of the condition. Treatment does not include routine physical examinations, eye examinations, or dental examinations.

3 A regimen of continuing treatment includes, for example, a course of prescription medication (e.g., an antibiotic) or therapy requiring special equipment to resolve or alleviate the health condition. A regimen of treatment does not include the taking of over-the-counter medications such as aspirin, antihistamines, or salves; or bed-rest, drinking fluids, exercise, and other similar activities that can be initiated without a visit to a health care provider.


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