HealthcareProviderFormWhat mustbe submittedfor a medicalleaveFamily andMedicalLeave Act(FMLA)The law thatallows timeoff for serioushealthconditionFMLA,CFRA,or ADAMental healthconditions canqualify forprotected leaveunder theselaws.PregnancyDisabilityLeave(PDL)Leave thatprovides 4months offforpregnancy12weeksNumber ofweeks FMLA& CFRAprovidesPaidFamilyLeave(PFL)Leave thatcan be usedfor mentalhealth needs  EmploymentDevelopmentDepartment(EDD)Agency thatmanagesSDI inCaliforniaHumanResources(HR)Whodeterminesleaveeligibility?CFRA,FMLA,or PFLType ofleave usedto bond witha newbornDomesticpartner &siblingsFamilymember typeCFRA coversthat FMLAdoes notFMLAorCFRALeave typethat protectsyour job duringpersonalillnessFMLALeave thatmay be usedintermittentlyFree!CaliforniaFamilyRights ActFullname ofCFRAStateDisabilityInsurance(SDI)Program thatprovides wagereplacementduring medicalleaveEmployers with50+ employees;Employee musthave 12+months & 1,250hours Qualificationsfor FMLAStateLawIf state leavelaw providesmore benefitsthan federallaw, which oneapplies?8weeksLength ofPaid FamilyLeavebenefitsFMLAandCFRATwo leavetypes thatcan run atthe sametimeHealthcareProviderFormWhat mustbe submittedfor a medicalleaveFamily andMedicalLeave Act(FMLA)The law thatallows timeoff for serioushealthconditionFMLA,CFRA,or ADAMental healthconditions canqualify forprotected leaveunder theselaws.PregnancyDisabilityLeave(PDL)Leave thatprovides 4months offforpregnancy12weeksNumber ofweeks FMLA& CFRAprovidesPaidFamilyLeave(PFL)Leave thatcan be usedfor mentalhealth needs  EmploymentDevelopmentDepartment(EDD)Agency thatmanagesSDI inCaliforniaHumanResources(HR)Whodeterminesleaveeligibility?CFRA,FMLA,or PFLType ofleave usedto bond witha newbornDomesticpartner &siblingsFamilymember typeCFRA coversthat FMLAdoes notFMLAorCFRALeave typethat protectsyour job duringpersonalillnessFMLALeave thatmay be usedintermittentlyFree!CaliforniaFamilyRights ActFullname ofCFRAStateDisabilityInsurance(SDI)Program thatprovides wagereplacementduring medicalleaveEmployers with50+ employees;Employee musthave 12+months & 1,250hours Qualificationsfor FMLAStateLawIf state leavelaw providesmore benefitsthan federallaw, which oneapplies?8weeksLength ofPaid FamilyLeavebenefitsFMLAandCFRATwo leavetypes thatcan run atthe sametime

Leave of Absence - Call List

(Print) Use this randomly generated list as your call list when playing the game. There is no need to say the BINGO column name. Place some kind of mark (like an X, a checkmark, a dot, tally mark, etc) on each cell as you announce it, to keep track. You can also cut out each item, place them in a bag and pull words from the bag.


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  1. What must be submitted for a medical leave
    Healthcare Provider Form
  2. The law that allows time off for serious health condition
    Family and Medical Leave Act (FMLA)
  3. Mental health conditions can qualify for protected leave under these laws.
    FMLA, CFRA, or ADA
  4. Leave that provides 4 months off for pregnancy
    Pregnancy Disability Leave (PDL)
  5. Number of weeks FMLA & CFRA provides
    12 weeks
  6. Leave that can be used for mental health needs
    Paid Family Leave (PFL)
  7. Agency that manages SDI in California
    Employment Development Department (EDD)
  8. Who determines leave eligibility?
    Human Resources (HR)
  9. Type of leave used to bond with a newborn
    CFRA, FMLA, or PFL
  10. Family member type CFRA covers that FMLA does not
    Domestic partner & siblings
  11. Leave type that protects your job during personal illness
    FMLA or CFRA
  12. Leave that may be used intermittently
    FMLA
  13. Free!
  14. Full name of CFRA
    California Family Rights Act
  15. Program that provides wage replacement during medical leave
    State Disability Insurance (SDI)
  16. Qualifications for FMLA
    Employers with 50+ employees; Employee must have 12+ months & 1,250 hours
  17. If state leave law provides more benefits than federal law, which one applies?
    State Law
  18. Length of Paid Family Leave benefits
    8 weeks
  19. Two leave types that can run at the same time
    FMLA and CFRA