Your WH-380-E certification form, section by section

What is the WH-380-E form?

The WH-380-E is the Department of Labor's optional certification form for leave under the Family and Medical Leave Act (FMLA) when the leave is for your own serious health condition. Its regulation, 29 CFR 825.306(b), puts it in one line: "Optional form WH-380E is for use when the employee's need for leave is due to the employee's own serious health condition."

Asking for a certification at all is your employer's choice. Under 29 CFR 825.305(a), an employer may require that leave for your own serious health condition be supported by a certification from your health care provider. It must tell you each time it requires one.

The WH-380-F is the Department of Labor's form for leave to care for a family member with a serious health condition.

Under 29 CFR 825.110 you are eligible if you work for a covered employer, at a worksite with 50 or more of its employees within 75 miles, and you have 12 months of employment with that employer and 1,250 hours of service in the 12 months before your leave begins. Eligibility is necessary and not sufficient: the absence must also be for a qualifying serious health condition, and your employer must designate it as FMLA leave.

What counts as a serious health condition has its own guide.

Does your employer have to use the WH-380-E?

No. The form is optional, and its own Section I instructions say so.

Under 825.306(b), your employer may use the Department of Labor's optional form or another form with the same basic information, but it may not require information beyond what the regulations allow. Those limits run from 825.306 through 825.308.

Whatever form your employer uses, the information it asks for must relate only to the serious health condition behind the current need for leave.

Who fills out each section of the WH-380-E?

Section I is the employer's section, though the form says either you or your employer may complete it. It asks for your name and your employer's, the date the certification was requested, the date it must be returned by, your job title, whether a job description is attached, your regular work schedule and a statement of the job's essential functions.

Section II is the health care provider's section. The provider completes and signs it, and it is divided into Parts A through C, described below.

The form tells the provider to return the completed form to you, the patient. It does not go straight to your employer. 29 CFR 825.306 says it directly: it is the employee's responsibility to provide the employer with complete and sufficient certification.

Certicare is a telehealth service where leave and accommodation paperwork is completed and signed by a state-licensed provider after an evaluation. On the WH-380-E, that is Section II, where the evaluation supports it, usually within 24 hours after we have everything needed.

There's usually no appointment, and a provider may follow up for more detail before deciding. Completing our intake form starts the review; it does not guarantee a signature, and if the review does not support your request you are refunded in full.

What does the provider's section ask for?

29 CFR 825.306(a) is the full list of what an employer may require in a certification. Section II gathers that information in lettered Parts.

Part A: Medical Information

Part A asks for medical facts about the condition. Under 825.306(a)(3), those medical facts "may include" a diagnosis. A diagnosis is not required on the certification.

The form also tells the provider not to include genetic information.

Part B: Amount of Leave Needed

Part B asks how much leave is needed. That can include time for planned treatment, or for unforeseeable episodes, where either applies. Leave taken in separate blocks is covered in intermittent FMLA explained.

Part C: Essential Job Functions

Part C asks whether you can perform the essential functions of your job. Section I is where your employer describes those functions.

What goes in each Part is the provider's judgment, made after the evaluation.

When is the WH-380-E due?

The deadline runs from your employer's request. Section I carries both dates, the day your employer asked and the day the form must be returned, and the form says your employer must give you at least 15 calendar days.

Under 29 CFR 825.305(b): "The employee must provide the requested certification to the employer within 15 calendar days after the employer's request, unless it is not practicable under the particular circumstances to do so despite the employee's diligent, good faith efforts or the employer provides more than 15 calendar days to return the requested certification."

A certification that arrives late does not undo everything before it. Per DOL Fact Sheet #28G, the days inside the 15-day window and the days from the day the complete certification is received are protected, and the exposed stretch is the one between the deadline's expiry and the day the certification arrives. If it is never produced, the leave is not FMLA leave.

Can FMLA be backdated covers those clocks.

Who can complete the provider's section?

The form calls for a health care provider, and 29 CFR 825.125 sets who counts. The list is wider than physicians. Nurse practitioners and physician assistants are at (b)(2).

Another of our guides sets out which providers can complete the certification.

What a state-licensed provider completes through Certicare is set out on medical leave forms.

What if the provider won't complete it, or it comes back incomplete?

No law requires a provider to complete it. If yours won't, doctor won't fill out FMLA paperwork covers the next steps.

Under 825.305(c), "A certification is considered incomplete if the employer receives a certification, but one or more of the applicable entries have not been completed. A certification is considered insufficient if the employer receives a complete certification, but the information provided is vague, ambiguous, or non-responsive."

In either case your employer must state in writing what is needed and allow seven calendar days to cure it, "unless not practicable under the particular circumstances despite the employee's diligent good faith efforts."

The same subsection ends: "A certification that is not returned to the employer is not considered incomplete or insufficient, but constitutes a failure to provide certification." The seven-day window belongs to a form your employer received. If your provider declined and nothing went back, the 15-day clock from your employer's request is the one running.

If your employer denies the leave, the guide to FMLA denials covers what comes next.

Answer the intake questions, and a state-licensed provider completes and signs Section II, where the evaluation supports it.