Form WH-380-F, Certification of Health Care Provider for Family Member’s Serious Health Condition under the FMLA, is the form used for letting your employer know that you’re going to use your FMLA leave to care for a family member.
It’s a simple form that needs to be completed by the employee, employer (optional), and the family member’s healthcare provider. After it’s filed, it goes on to stay in the records. The form also outlines the serious health condition of the family member and the estimated amount of leave needed for the employee to provide care.
Content of Form WH-380-F
Form WH-380-F is made up of three main sections. Section I is for the employer, Section II is for the employee, and Section III is for the healthcare provider. The people stated above must file all three sections for the WH-380-F to be valid.
Enter the basic personal information of the employee and the employer. It also includes the date the form was requested and when the medical certification must be returned.
This section of WH-380-F lists the family member’s relationship to the employee, the care that the employee will provide, and the employee’s estimate of the amount of leave needed.
Healthcare provider’s section
The healthcare provider will detail the family member’s health condition and give an estimate on the amount of leave needed for the employee to care for the family member.
Fill out Form WH-380-F online
Get the WH-380-F from above and start filling out an online copy. Once filed, you can save it as a PDF file to forward to your employer and the healthcare provider, making things a lot easier. After all parties complete form WH-380-F, make sure to keep a copy for your own records in case of any violations.