WH-380-E: The FMLA Medical Certification Form Explained

Form WH-380-E is the U.S. Department of Labor’s optional form a health care provider uses to certify a serious health condition when an employee needs FMLA leave for their own medical reasons. Your employer gives you the form, your provider completes the medical sections, and you return it to your employer, generally within 15 calendar days. The form supports your leave request, and your employer or leave administrator makes the final decision. The form is a structured questionnaire, and knowing what each section asks makes it easier to get it right the first time.

Key takeaways

WH-380-E covers leave for your own serious health condition. A separate form, WH-380-F, covers leave to care for a family member. The DOL calls both optional, and employers may use their own forms if they ask for the same basic information (DOL).
Under 29 CFR 825.305, you generally have at least 15 calendar days after your employer’s request to return a complete certification, plus 7 calendar days to fix problems your employer identifies in writing.
Make sure your employer completed Section I, get the form to a provider early, and check every answer before you hand it in.

What is Form WH-380-E?

Form WH-380-E is the “Certification of Health Care Provider for Employee’s Serious Health Condition,” published by the DOL’s Wage and Hour Division. The Family and Medical Leave Act (FMLA) is the federal law that lets eligible employees take unpaid, job-protected leave for certain medical and family reasons, and this form is how a provider documents the medical side of that request.

The completed form goes to your employer, not to the DOL. The Department says completed certifications pass between employee and employer and should not be sent to the Wage and Hour Division (DOL).

The questions on the form track what the regulations allow an employer to ask. According to 29 CFR 825.306, that includes the provider’s contact details and type of practice, when the condition started, how long it is likely to last, appropriate medical facts, and whether you can perform the essential functions of your job.

WH-380-E vs. WH-380-F: which form do you need?

You need WH-380-E when the leave is for your own health condition, and WH-380-F when the leave is to care for a spouse, child, or parent with a serious health condition. The two forms look similar, but they ask different questions, so using the wrong one usually means starting over.

WH-380-E (employee): Asks whether you can perform your job functions and how much leave you need for your own care.
WH-380-F (family member): Asks about the family member’s condition and the care you will provide, such as transportation or help with basic needs.

If you are not sure which situation applies, our guide to FMLA forms and how to complete them walks through every form your employer might send.

Who needs this form, and who is eligible for FMLA?

Any employee whose employer requests medical certification for their own serious health condition may receive this form. Eligibility for FMLA itself is a separate question that your employer answers first, often with a notice called the WH-381.

The DOL describes general eligibility this way: you work for a covered employer, have worked there at least 12 months, have at least 1,250 hours of service in the 12 months before leave, and work at a location with at least 50 employees within 75 miles (DOL Fact Sheet #28). Your HR department or leave administrator can confirm how these rules apply to your job.

It also helps to know what FMLA does. FMLA provides job-protected leave, up to 12 workweeks in a 12-month period for eligible employees, but it does not replace your income. Short-term disability (STD) may replace part of your pay, but it does not by itself protect your job. Many people need both, and our overview of FMLA and short-term disability explains how they work together.

What does each section of WH-380-E ask?

The form has two main parts: your employer completes Section I, and your health care provider completes Section II. Here is what each part covers and what tends to go wrong.

Section I: For the employer

Your employer fills in your name, job title, regular work schedule, and the essential job functions of your position, or attaches a job description. This section also states the date the certification must be returned, which must allow at least 15 calendar days.

If Section I is blank, ask HR to complete it before you see your provider. Your provider needs to know what your job involves to answer the later questions about what you can and cannot do.

Section II, Part A: Medical information

Your provider records when the condition began and how long it is likely to last. The provider then checks which category of serious health condition applies. These categories come from 29 CFR 825.114 (inpatient care) and 29 CFR 825.115 (continuing treatment):

Inpatient care: An overnight stay in a hospital, hospice, or residential medical facility.
Incapacity plus treatment: More than three consecutive full calendar days of incapacity, along with qualifying treatment.
Pregnancy or prenatal care: Any period of incapacity related to pregnancy, including prenatal visits.
Chronic condition: A condition that requires periodic visits at least twice a year, continues over time, and may cause episodic flare-ups, such as asthma, diabetes, or migraines.
Permanent or long-term condition: A condition where treatment may not be effective, but the person stays under a provider’s supervision.
Multiple treatments: Conditions that require repeated treatment, such as chemotherapy, dialysis, or restorative surgery.

The form notes that the provider may share additional medical facts, such as symptoms or a diagnosis, but is not required to do so.

Section II, Part B: Amount of leave needed

This part turns medical information into a schedule your employer can plan around. The provider estimates time needed for planned treatment, a reduced work schedule, a continuous period of incapacity, and intermittent leave (leave taken in separate blocks of hours or days rather than all at once). For flare-ups, the provider estimates how often they may happen and how long each one may last.

Specific estimates work much better than vague ones. “Up to 2 flare-ups per month, each lasting 1 to 2 days” gives your employer something usable, while “as needed” often triggers a follow-up request. Our guide to intermittent FMLA frequency and duration explains how to think through those numbers with your provider.

Section II, Part C: Essential job functions

The provider identifies which essential job functions you cannot perform during the leave period. This part is far easier to complete accurately when Section I lists your job duties clearly.

Does WH-380-E require a diagnosis?

No, the regulations do not require a diagnosis on the form. Instead, they call for appropriate medical facts that support the need for leave (29 CFR 825.306).

The form also tells providers not to include genetic information, including family medical history, in line with the Genetic Information Nondiscrimination Act (EEOC). If you are comfortable having a diagnosis listed, it may reduce back-and-forth with HR. That is your choice to discuss with your provider.

How to get WH-380-E completed

The general sequence below applies to most employers, though the dates in your employer’s notices control your own timeline.

Tell your employer you need leave. Employers generally request certification when you give notice or within five business days after (29 CFR 825.305).
Get the form and the deadline. Your employer provides WH-380-E or its own version, along with a return date at least 15 calendar days away.
Check Section I. Confirm your job functions and schedule are filled in before your appointment.
See a provider. The provider completes Section II based on a genuine medical evaluation of your condition.
Review before you submit. Look for blank answers, missing dates, and leave estimates without numbers.
Return it and keep a copy. Note the date you submitted it and how.

If you do not have a regular provider, or your provider cannot complete the form before your deadline, you still have options. Our article on why your PCP may not sign your forms covers the most common reasons and alternatives.

A licensed provider who evaluates you by secure video may be able to complete the certification if your condition qualifies. Through MyFMLA, a board-certified physician reviews your situation in a short video visit and completes the paperwork only when it is medically appropriate. Certification supports your request, and your employer or leave administrator decides. You must book for the state where you will be physically located at the time of the visit.

Common mistakes that delay WH-380-E

Most delays come from small, preventable problems. The DOL describes a certification as incomplete when an applicable entry is left blank and insufficient when the answers are vague, unclear, or nonresponsive (DOL Fact Sheet #28G).

Blank fields: Every applicable question needs an answer, including dates and the condition category.
Vague frequency estimates: “As needed” or “unknown” leaves your employer without numbers to approve.
Missing job functions: Without Section I, your provider cannot answer Part C well.
Waiting until the last few days: The 15-day window has to cover scheduling, the visit, and getting the form back.
Sending it to the DOL: The completed form goes to your employer.

If your employer finds a problem, it must tell you in writing what is missing, and you generally have seven calendar days to fix it (29 CFR 825.305). Failing to provide a complete certification can lead to the leave being denied, so it is worth acting quickly.

Can my employer contact my doctor about the form?

Yes, in limited ways. Under 29 CFR 825.307, a health care provider, human resources professional, leave administrator, or management official may contact your provider to confirm the form is authentic or to clarify an unclear answer. Your direct supervisor may not make that contact.

Employers must follow HIPAA privacy rules and cannot ask for information beyond what the certification form requests.

How often can an employer ask for recertification?

Employers generally may request recertification no more often than every 30 days, and only in connection with an absence. If the certification says your condition will last longer than 30 days, the employer usually waits until that period ends, though it may ask every six months even for long-term conditions (29 CFR 825.308).

Recertification can also be requested sooner if circumstances change significantly, such as more frequent absences than the form estimated. If your leave needs change, MyFMLA physicians also handle follow-up forms, extensions, and recertifications.

When to seek medical attention

Paperwork should never delay urgent care. This is not an emergency service. In an emergency, call 911 or go to the nearest emergency room. If your condition changes or gets worse, contact your treating provider promptly, and let HR know that your leave needs may change.

If your leave is related to depression, anxiety, or another mental health condition and you are having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988 at any time.

Frequently asked questions

Is WH-380-E required? No. The DOL calls the form optional, and employers may use their own forms if they request the same basic information.

How long do I have to return WH-380-E? Generally at least 15 calendar days after your employer’s request, unless that is not practicable despite your diligent, good-faith efforts (29 CFR 825.305). If you need more time, tell HR before the deadline and explain why.

Who can complete WH-380-E? The DOL lists physicians, nurse practitioners, physician assistants, psychologists, clinical social workers, and certain other providers (DOL Fact Sheet #28G). Your employer or benefits administrator can tell you whether it accepts a particular type of provider.

Can I fill out part of the form myself? You can fill in your name and confirm the employer section is complete, but Section II must be completed by your health care provider. A provider’s answers need to come from an actual evaluation of your condition.

Does WH-380-E guarantee my leave is approved? No. A completed form supports your request, and your employer or leave administrator decides whether you meet the FMLA requirements.

Do I need a new WH-380-E every year? Not automatically. Recertification timing depends on your condition, your absences, and the limits in 29 CFR 825.308. Many employers also ask for a new certification at the start of a new leave year, so check your employer’s policy.

Next steps

If your own provider cannot complete WH-380-E before your employer’s deadline, a board-certified physician can evaluate you by secure video and complete the certification if it is medically appropriate. MyFMLA offers intermittent FMLA and continuous FMLA certification, and intermittent certification is generally completed within 1 business day when all required information is available. Current pricing is listed on the booking page, where you can start your evaluation.

Sources

Medical documentation supports your request but does not guarantee approval. Final decisions are made by your employer, insurance carrier, leave administrator, school, or applicable state program.

This article is for informational purposes only and is not a substitute for professional medical advice.

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