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Detailed Answer — How to handle missed work without a doctor’s note (Missouri)

Employers often ask for medical documentation when employees miss work for illness or emergency care. Missouri does not require private employers to provide paid sick leave, so your pay and job-protection rights depend on your employer’s policies, any employment contract, and federal laws that may apply (for example, the Family and Medical Leave Act (FMLA) if your employer is covered and you qualify).

If you do not have an immediate doctor’s note after an ER visit, take these steps:

1. Check your employer’s written policy or handbook. Find what documentation your employer requires, how much time you have to submit it, and whether electronic copies are accepted.
2. Tell your employer promptly and in writing. Inform them of the ER visit, how long you were out, and that you’ll provide documentation as soon as possible. Keep a copy of this message. Prompt communication reduces the chance of discipline.
3. Ask the ER for immediate paperwork you can use. Most emergency departments provide a printed discharge summary, visit summary, or billing statement at check-out. These items often show the date/time of the visit and a brief reason for care and can be given to your employer as interim proof.
4. Request your official medical records under federal HIPAA rules. You have a right to copies of your medical records. Use the ER’s medical records request form or make a written request. Many hospitals can email or mail a discharge summary, operative note, or medical record extract within days. See the HHS guide on getting medical records: https://www.hhs.gov/hipaa/for-individuals/medical-records/index.html
5. Provide alternative supporting documentation. If a formal note is delayed, use:
   • ER discharge summary or after-visit summary;
   • ER or hospital billing statement showing dates of service;
   • Prescription receipts or pharmacy printouts from the visit;
   • Ambulance or transport paperwork if used;
   • Notes from follow-up appointments when obtained.
6. If your employer asks for certification under FMLA and you may be eligible, use the FMLA process. If your employer is covered (generally 50+ employees within 75 miles) and you meet eligibility, the employer can require medical certification. You should follow the employer’s request but can submit ER records and the provider’s notes when available. See the federal FMLA overview: https://www.dol.gov/agencies/whd/fmla
7. If you have a disability affecting work attendance, consider ADA accommodations. If the ER visit relates to a condition that substantially limits major life activities, you might request temporary accommodation (for example, paid leave or schedule changes). Employers may ask for medical information sufficient to support the request, but medical confidentiality rules limit what they may ask. See the EEOC for ADA guidance: https://www.eeoc.gov
8. If your absence was due to a work injury, file a workers’ compensation claim. For workplace injuries, your employer’s workers’ compensation insurer handles medical payments and wage replacement. Contact Missouri’s Division of Workers’ Compensation for process details: https://labor.mo.gov/divisions/dwc
9. If your employer disciplines or denies pay unfairly, contact Missouri labor authorities. If you believe your employer violated wage/pay policies, withheld pay, or retaliated illegally, you can contact the Missouri Department of Labor for guidance: https://labor.mo.gov/

In short: communicate quickly, gather any ER paperwork you already have, request official records under HIPAA, provide reasonable temporary documentation, and follow any FMLA/ADA processes if they apply.

How to request ER records quickly (step-by-step)

1. Contact the hospital/ER medical records department the same day (or next business day). Ask for an “after-visit summary” or “discharge summary.”
2. Complete any medical records release form the hospital requires. Ask whether they will accept emailed/online forms for faster processing.
3. Ask for an itemized billing statement (this often ships faster and shows the date/time of visit).
4. If records are delayed, ask for a dated staff-signed note that verifies you were seen and the date; many ERs can provide this quickly.
5. Keep a record of every request (dates, who you spoke with, and confirmation numbers).

HHS guidance on getting medical records: https://www.hhs.gov/hipaa/for-individuals/medical-records/index.html

What employers may lawfully request — and what to watch for

• Employers commonly request documentation of dates you were under a provider’s care. They generally may not demand full medical records beyond what’s necessary to support leave or accommodation requests.
• Under FMLA (if applicable), employers can require certification and may seek clarification/second opinions in limited circumstances. Federal FMLA resources: https://www.dol.gov/agencies/whd/fmla
• Medical information should be kept confidential by your employer. If you believe your employer improperly disclosed your medical information, consult federal HIPAA/EEOC guidance.

Helpful Hints

• Act fast: immediate communication and paperwork requests reduce disputes.
• Collect everything you received at the ER (discharge papers, prescriptions, receipts).
• Use email where possible so you have a written timeline showing you notified your employer.
• Keep originals and make copies of any records you submit.
• If you expect ongoing absences, ask about intermittent FMLA leave if you qualify.
• If you can’t afford medical record fees, ask the hospital for low-cost copies or explain urgency — many facilities will expedite employment-related requests.
• If you face discipline or termination and believe it’s unlawful, contact the Missouri Department of Labor: https://labor.mo.gov/
• Save a clear timeline of the incident, who you told at work, and any responses from your employer.