Federal employment leave

FMLA Employee Serious Health Condition Certification (Form WH-380-E)

Help a health care provider certify an employee's FMLA leave

Form WH-380-E is the Department of Labor's optional form for health care providers to certify that an employee has a serious health condition under the Family and Medical Leave Act.

Start the walkthrough View the official source

Average time

15-25 minutes

Difficulty

detail-heavy

Best for

Health care providers certifying an employee's FMLA serious health condition.

What this form stands for

Return a complete certification to the employee within the employer's deadline.

Use WH-380-F instead if the leave is to care for a family member's condition.

What you'll need

Employee and employer details from Section I
Diagnosis-related facts limited to the condition causing leave
Estimated leave timing: continuous, intermittent, or reduced schedule

How the walkthrough is organized

Employer and employee context

Who is requesting leave and job context.

Medical condition type

Which serious health condition categories apply.

Leave amount needed

Treatment dates, incapacity, and intermittent patterns.

Essential job functions

Whether the employee can perform essential duties.

Ready to start?

Docgle asks calm, plain-English questions and keeps the official source attached for review.

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