FMLA: Forms | U.S. Department of Labor
Summary: Form WH-380-F is the official U.S. Department of Labor document used by health care providers to certify a family member's serious health condition for FMLA leave eligibility.
Form WH-380-F, 'Certification of Health Care Provider for Family Member’s Serious Health Condition,' is a standardized document provided by the U.S. Department of Labor's Wage and Hour Division. It allows employers to request medical certification from an employee seeking FMLA leave to care for a family member. The form includes sections for the employer to initiate the request, the employee to describe the care needed, and the health care provider to verify the medical necessity and duration of the condition. It outlines the legal requirements for FMLA, including definitions of serious health conditions and the 15-day timeframe for submission.
Document outline
1. Section I: Employer Information and Request 2. Section II: Employee Information and Care Description 3. Section III: Health Care Provider Certification 4. Part A: Medical Information (Diagnosis, Duration, Necessity) 5. Part B: Amount of Leave Needed (Intermittent, Continuous, or Reduced Schedule) 6. Definitions of a Serious Health Condition 7. Paperwork Reduction Act Notice