Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Certification of Health Care Provider for Employee’s Serious Health Condition under the Family and Medical Leave Act

Form ID:

WH-380-E

Control ID:

1235-0003

Expiration date:

Fri, 31 Aug 2029 - 23:59

Forms

WH-380-E: Certification of Health Care Provider for Employee’s Serious Health Condition under the Family and Medical Leave Act

The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued by the employee’s health care provider. 29 U.S.C. §§ 2613, 2614(c)(3); 29 C.F.R. § 825.305. The employer must give the employee at least 15 calendar days to provide the certification. If the employee fails to provide complete and sufficient medical certification, his or her FMLA leave request may be denied. 29 C.F.R. § 825.313.