Our forms are available for you to print out and fill in before coming to our office. This can save you time. We also have forms to facilitate retrieving your medical records. All our forms are produced in Acrobat format PDF. If you need the free reader, click here and it can be downloaded to your computer.

CA STATE DISABILITY   

California state law provides for disability income for qualified women beginning 4 weeks prior to their initial due date, regardless of when they actually deliver.   The diagnosis for this standard disability is simply “Pregnancy.”  We use other diagnoses for other conditions if a woman must leave work earlier than the 4-week mark.  Disability payments will continue for 6 weeks following a vaginal delivery and 8 weeks following a cesarean section.  We now have the CA State Disability form available to pick up in our office or you may complete it online at http://www.edd.ca.gov. However, when completing the form online it will only process if you submit the day AFTER your last day of work as the site will not accept future dates.  If you choose to submit online, please call the office with the R# (which will be provided once you submit your form) and your last date of work.

If you choose to submit a paper form, please request this form well in advance of your planned Disability Leave.  Remember to use BLACK INK!  The state will not accept forms that were filled out in any color other than black.

For more detailed instructions, click here.  If you require any further assistance, direct questions to Jess at Jess-MA@StephenWellsMD.com.

FMLA/BABY BONDING

 If you wish to take FMLA/Baby Bonding time, which allows 4 additional weeks of paid leave, you will need to complete the DE 2588.  Please note that as the mother, you will automatically be sent this form at the conclusion of your maternity disability leave. If your partner wishes to take FMLA/Baby Bonding time, call the state to request the proper paperwork: 877-238-4373.   If the form is for you as the mother, it does not require any information to be completed by a doctor’s office and you may mail it back to the state after your child has been born (as it requires your child’s date of birth and social security number); however, if it is for your spouse/partner, please bring the form to Jess to complete our portion.

EMPLOYER DISABILITY FORMS

If your employer requires additional disability forms, these may also be completed by Jess, along with any doctor’s notes/letters as needed.