Form wh 380 e 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section I, where the employer must provide their name, contact information, and details about the employee's job title and essential functions. Ensure all fields are filled accurately.
3. Move to Section II for the employee's information. Fill in your full name and ensure you complete this section before handing it over to your healthcare provider.
4. In Section III, the healthcare provider will need to provide detailed medical facts regarding the condition. This includes dates of treatment, whether hospitalization was required, and any prescribed medications.
5. Complete Part A by answering questions about the medical condition's duration and treatment needs. Be specific about any job functions that may be affected.
6. In Part B, estimate the amount of leave needed based on incapacity periods and follow-up treatments. Clearly outline any necessary adjustments to work schedules.
7. Finally, ensure that the healthcare provider signs and dates the form before submission.

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