WH-380-E
Certification of Health Condition for FMLA Leave
Medical certification form used by employees requesting FMLA leave for their own serious health condition.
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About WH-380-E — Certification of Health Condition for FMLA Leave
Form WH-380-E is the Department of Labor's official FMLA medical certification form used when an employee requests leave for their own serious health condition. The employer provides the form to the employee, who has 15 calendar days to return a completed certification from their healthcare provider. The form asks the healthcare provider to describe the medical condition, the expected duration of leave, and whether the condition qualifies as a serious health condition under the FMLA. Employers may not contact the healthcare provider directly but may authenticate the certification or seek a second opinion. Employees are entitled to up to 12 weeks of unpaid, job-protected FMLA leave per year.
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WH-380-E is an official form published by DOL. Official source
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