Fill out WH-380-F (FMLA Certification - Family Member's Serious Health Condition) online
Form WH-380-F is used under the Family and Medical Leave Act (FMLA) to certify that an employee's request for FMLA leave is due to a family member's serious health condition. FMLA allows eligible employees to take up to 12 weeks of unpaid, job-protected leave to care for a spouse, child, or parent with a serious health condition.
How to fill out WH-380-F (FMLA Certification - Family Member's Serious Health Condition)
Employee completes Section I
Enter your name, employer name and address, and the name of the family member you will be caring for. Specify your relationship (spouse, child, or parent) and describe the care you will provide.
Healthcare provider describes the family member's condition
The family member's healthcare provider describes the serious health condition, including when it commenced, its probable duration, and whether the family member is currently incapacitated.
Detail the care needed
The healthcare provider specifies whether the family member needs assistance with basic medical, hygienic, nutritional, safety, or transportation needs, and whether the employee's presence would be beneficial for the family member's care or recovery.
Address intermittent leave needs
If intermittent leave or a reduced schedule is needed, the healthcare provider estimates the frequency and duration of the family member's episodes and explains why the employee's intermittent presence is medically necessary.
About WH-380-F (FMLA Certification - Family Member's Serious Health Condition)
Who needs this form
Employees requesting FMLA leave to care for a spouse, child, or parent with a serious health condition. The employer provides the form, the employee gives it to the family member's healthcare provider, and the completed form is returned to the employer.
Where to submit
The completed form is returned to the employee's employer, typically the HR department. The employer must allow at least 15 calendar days to return the certification.
Source and content freshness
- Filing deadlines may shift for weekends and holidays. Verify due dates with official instructions.
Common mistakes to avoid
- Not specifying the care the employee will provide to the family member
- Healthcare provider not indicating whether the family member needs assistance for basic activities
- Forgetting to indicate the relationship between the employee and the family member
- Not providing sufficient detail about why the employee's presence is necessary
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