FMLA Certification of Health Care Provider for Employee's Serious Health Condition
(Form WH-380-E)

Summary

This template is a Certification of Health Care Provider for Employee's Serious Health Condition under the Family and Medical Leave Act (FMLA) (DOL Form WH-380-E). It allows a healthcare provider to certify an employee's serious health condition. It contains practical guidance and drafting notes. This template is intended for private employers. It is based on federal law and does not address all potential state law distinctions; thus, you should check any relevant state and local laws. For a full listing of key content covering leaves for employees, see Leaves for Employees Resource Kit. For more information on medical certification, see Family and Medical Leave Act § 8.01–8.11. For a full listing of key content covering leaves for employees in California, see Leaves for Employees Resource Kit (CA). For other key FMLA notices, see Certification of Health Care Provider for Family Member's Serious Health Condition under the Family and Medical Leave Act (DOL Form WH-380-F), Notice of Eligibility and Rights & Responsibilities under the Family and Medical Leave Act (DOL Form WH-381), and Designation Notice under the Family and Medical Leave Act (DOL Form WH-382). For more information, see Family and Medical Leave Act Administration and Audit Checklist.