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There are five DOL optional-use FMLA certification forms. Certification of Healthcare Provider for a Serious Health Condition. Employee’s serious health condition, form WH-380-E - Use when a leave request is due to the medical condition of the employee.
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 ...
Revised WH-347 Form & Instruction Applicable to Contracts Entered into Pursuant to Invitations for Bids Issued or Negotiations Concluded On or After January 18, 2009. WH-380-E : FMLA Certification of Health Care Provider for Employee’s Serious Health Condition
WH-380-E (Certification of ... Skip to main content. An official website of the United States government. Here's how you know. Here's how you know. The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site. ... Forms; WH-380-E ...
The FMLA permits an employer to require that you submit a timely, complete, and sufficient medical certification to support a request for FMLA leave due to your own serious health condition. If requested by your employer, your response is required to obtain or retain the benefit of FMLA protections. 29 U.S.C. §§ 2613, 2614(c)(3).
Your patient has requested leave under the FMLA. The FMLA allows an employer to require that the employee submit a timely, complete, and sufficient medical certification to support a request for FMLA leave due to the serious health condition of the employee.
The current FMLA Medical Certification Form for Employee’s Serious Health Condition - WH-380-E permits, but does not require, that the healthcare provider include a diagnosis. Note that the FMLA regulations do not specify to whom the medical certification must be provided, but only indicate that it must be provided to the agency.
