Fill out WH-380-E (FMLA Certification - Employee's Serious Health Condition) online
Form WH-380-E is used under the Family and Medical Leave Act (FMLA) to provide medical certification supporting an employee's request for FMLA leave due to their own serious health condition. A serious health condition includes any illness, injury, impairment, or physical or mental condition that involves inpatient care or continuing treatment by a healthcare provider.
How to fill out WH-380-E (FMLA Certification - Employee's Serious Health Condition)
Employee completes Section I
Enter your name, the name and address of your employer, and your job title. Describe the essential job functions you are unable to perform due to your health condition.
Healthcare provider describes the condition
The healthcare provider describes the serious health condition, including the approximate date it commenced, its probable duration, and whether the patient is currently incapacitated.
Specify the treatment regimen
The healthcare provider details the treatment plan, including the frequency and duration of treatments, whether hospitalization is required, and any prescribed medications that may affect the ability to work.
Address intermittent leave needs
If intermittent leave or a reduced work schedule is needed, the healthcare provider must estimate the frequency and duration of episodes, and explain why the intermittent schedule is medically necessary.
About WH-380-E (FMLA Certification - Employee's Serious Health Condition)
Who needs this form
Employees requesting FMLA leave for their own serious health condition. The employer provides this form to the employee, who then gives it to their healthcare provider to complete. The employer must allow at least 15 calendar days to return the certification.
Where to submit
The completed form is returned to the employee's employer, typically the HR department. The employer may not contact the employee's healthcare provider directly; they must use a healthcare provider or HR professional to clarify or authenticate the certification.
Source and content freshness
- Filing deadlines may shift for weekends and holidays. Verify due dates with official instructions.
Common mistakes to avoid
- Healthcare provider not specifying the probable duration of the condition
- Not indicating whether intermittent leave or a reduced schedule is medically necessary
- Returning the form after the 15-day deadline without requesting an extension
- Providing vague or incomplete medical information that requires follow-up
Frequently asked questions
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Can my employer deny FMLA leave if I submit this form?
If the certification is complete and supports the need for FMLA leave, the employer cannot deny the leave. However, if the certification is incomplete or insufficient, the employer must give you 7 calendar days to cure the deficiency. The employer may also request a second opinion from a different healthcare provider at the employer's expense.
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