WH 380 E Form

Form WH 380 E—Certification of Health Care Provider for Employee’s Serious Health Condition under the FMLA is the form for employees to request leave from their employers for their own health conditions.

If you’re a worker, you are going to file this FMLA form to request up to 12 weeks of leave under the FMLA. The current Form WH 380 E is going to be expired in 2023. So, you can use it for the entirety of 2023, and 2024.

Note: Form WH 380 E isn’t mandatory to file for FMLA leave. This FMLA form is used mostly to get information from the health care provider to create a medical certification. This is also used for finding out how many days the employee needs. The amount of leave needed refers to the days the employee needs before returning back to work.

Content of Form WH 380 E

With that said, Form WH 380 E is made up of two parts. Section 1 can be completed by both employers and employees. On the other hand, Section 2 must be completed by the healthcare provider of the employee. While Section 1 is pretty easy to file Section 2 requires a healthcare professonional.

Section 2 is then further divided into three separate parts. In order from Part 1 to 3, these are about:

• Medical Information
• Amount of Leave Needed
• Essential Job Functions

Perhaps, the most important part of Form WH 380 E—aside from it being the medical certification for FMLA is that it states the amount of leave the employee needs. This protects employers from employees taking leave under the FMLA for longer periods of time than they actually need.

Since these are going to be entered by the healthcare provider of the employee, there shouldn’t be any wrongdoings.

As for how you can file a Form WH 380 E—Certification of Health Care Provider for Employee’s Serious Health Condition under the Family and Medical Leave Act, start filling out below.

As soon as you’re done filing Form WH 380 E, click the print icon on the top right and select edited to print out the one you filed. The same applies if you want to download it as a PDF.

Take note that Form WH 380 E must be returned to the employer before the date entered on Section 1, Line 3. Employees will have 15 calendar days from the date it was requested. Form WH 380 E must be returned to the employer before it’s due.