WH-380E 2025

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The document outlines the Certification of Health Care Provider for an Employee's Serious Health Condition under the Family and Medical Leave Act (FMLA). It details the requirements for employees to submit medical certification from their health care provider when requesting FMLA leave due to serious health conditions. The form includes sections for employer and health care provider information, medical details about the condition, and the amount of leave needed. It emphasizes confidentiality and proper handling of medical records, as well as compliance with FMLA regulations.

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Click ‘Get Form’ to open the WH-380E in the editor.
Begin with Section I, where you can enter the employee's name, employer's name, and the date certification was requested. Ensure that you allow at least 15 calendar days for the medical certification to be returned.
In Section II, health care providers should fill in their contact information and provide details about the patient's serious health condition. Be specific about treatment dates and any necessary medical facts.
Complete Part A by detailing the medical condition(s) for which leave is being requested. Include start dates and duration estimates as accurately as possible.
In Part B, specify the amount of leave needed based on the medical conditions checked in Part A. Provide detailed estimates for planned treatments and any required reduced work schedules.
Finally, ensure that all sections are completed accurately before signing and dating the form in Part C.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can a physical therapist fill out FMLA paperwork?

FMLA is supposed to be filled out by the treating physician, when you file they send you a copy and the doctors office a copy. Ya know, because theyre supposed to fill it out, not us.

What paperwork does a doctor need to fill out for FMLA?

FMLA Form WH-380-F for Family Health Condition Provide information about the family member and your relation to them to help confirm your eligibility for leave. This form has the same three sections as the above WH-380-E and will ask you to confirm the amount of leave you require.

What is the WH-380-E form?

Employees serious health condition, form WH-380-E - Use when a leave request is due to the medical condition of the employee.

Why are doctors hesitant to fill out FMLA paperwork?

While doctors can refuse if the information requested is outside their expertise or not medically necessary, they typically must provide sufficient documentation for the leave. Employees or their representatives should ensure forms are properly submitted and may follow up with the provider or employer if delays occur.

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