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The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued by the employee’s health care provider. 29 U.S.C. §§ 2613, 2614(c)(3); 29 C.F.R. § 825.305. The employer must give the ...
WH-380-E (Certification of ... FY 2023 Agency Financial Report; Records and Reports; Budget Justification; Evaluation; Our Commitment to Transparency; Policy and Strategy; Partner with Us. How to Work with USAID; ... Forms; WH-380-E (Certification of Health Care Provider for Employee's Serious Health Condition)
WH-380-E.pdf — PDF document, 284 KB (291515 bytes) Certification of Health Care Provider for Employee’s Serious Health Condition under the Family and Medical Leave Act. Form expires June 30, 2023.
Fillable Form WH 380-E. This medical certification form will provide the office with information needed to determine if the employee’s requested leave is for a qualifying reason under the Family and Medical Leave Act or FMLA. FILL ONLINE. EMAIL.
Form WH 380-E, Certification of Health Care Provider for Employee's Serious Health Condition, is a form used by employers and sent to the US Department of Labor, Wages and Hour Division. This form verifies that an employee has a serious medical condition.
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INSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued by the employee’s health care provider.
