This government document is issued by Department of Fair Employment and Housing for use in California
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https://www.google.com/url?client=internal-element-cse&cx=001779225245372747843:baq94yxn95w&q=https://calcivilrights.ca.gov/wp-content/uploads/sites/32/2022/09/Pregnancy-Certification-Health-Care-Provider_ENG.pdf&sa=U&ved=2ahUKEwjp37PDycSHAxVB2AIHHSI0AH04FBAWegQIBBAB&usg=AOvVaw2AS77kFZQ4rPN34aI_OgGy