Federal employment leave
FMLA Employee Serious Health Condition Certification (Form WH-380-E)
Help a health care provider certify an employee's FMLA leave
What is Form 380-E used for?
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.
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.
Time, difficulty & who this form is for
Average time
15-25 minutes
Difficulty
detail-heavy
Best for
Health care providers certifying an employee's FMLA serious health condition.
What do I need before I start?
- 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.
What happens after I complete it?
Answer the questions, review your document, then follow its official signing and delivery instructions. Downloading does not submit the form.
Start dol-wh-380e-fmla-healthcare-provider-certification walkthrough