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How to use or fill out form WH-380-E with our platform
- Click ‘Get Form’ to open it in the editor.
- 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.
- 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.
- 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.
- 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.
- 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.
- Finally, ensure that the healthcare provider signs and dates the form before submission.
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