WH-380-F
Certification of Family Member Health Condition (FMLA)
FMLA medical certification for employees requesting leave to care for a family member with a serious health condition.
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About WH-380-F — Certification of Family Member Health Condition (FMLA)
Form WH-380-F is the FMLA medical certification for employees requesting leave to care for a qualifying family member — a spouse, child, or parent — with a serious health condition. Like WH-380-E, it is completed by the family member's healthcare provider and must be returned within 15 calendar days. The form documents the nature of the condition, anticipated duration, and the need for care by the employee. Caring for a domestic partner or sibling requires state family leave laws (which may be broader) rather than federal FMLA. The employer provides the appropriate FMLA certification form within 5 days of the leave request.
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WH-380-F is an official form published by DOL. Official source
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