Main reason for leave planning Appointments or care coordination Hospital, rehab, or nursing facility transition Temporary daily care increase Possible serious health condition Serious illness, hospice, or end-of-life support
Relationship to person needing care Parent Spouse Adult child Other family member Not sure if covered
Work situation Full-time employee Part-time employee Multiple jobs Self-employed or contract work Not sure
FMLA or employer coverage Employer may be covered Small employer or unclear coverage Not sure yet Leave already approved
Likely time away from work Intermittent appointments or care days One continuous block of leave Reduced work schedule Unpredictable urgent needs
Paid leave or wage replacement Not checked yet State paid-leave program may apply Employer paid time may apply No paid option known
Documentation status Not started Forms received Need clinician or care-team help Deadline is close or missed
Privacy comfort with employer Need a short HR script Comfortable with HR process May have shared too much already Not sure what to share
Backup care if leave is delayed No backup care yet Thin or unreliable backup Some steady backup exists Paid or agency help is involved
Timing Need to act this week Planning this month Planning ahead Leave request already in progress
Use broad work-planning details only.
Do not enter names, employer identifiers, diagnoses, Social Security numbers, Medicare numbers, account numbers, full medical records, or private HR paperwork. Keep personal and employment records in secure private files.
This planner is educational and organizational only. It is not legal, employment, benefits, tax, financial, medical, or insurance advice. Confirm your situation with HR, the official leave administrator, a qualified professional, or legal aid when rights or deadlines are unclear.
Trusted references:
DOL FMLA family caregiver information ,
DOL FMLA fact sheet ,
ACL caregiver support ,
Eldercare Locator .
