Search results
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.
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.
1 cze 2020 · Download Fillable Form Wh-380-e In Pdf - The Latest Version Applicable For 2024. Fill Out The Fmla Certification Of Health Care Provider For Employee's Serious Health Condition Online And Print It Out For Free.
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.
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.
For Download, please click on the Certification of Health Care Provider for Employee’s Serious Health Condition (Family and Medical Leave Act Form WH 380 E).
INSTRUCTIONS to the EMPLOYEE: Please complete Section II before giving this form to your medical provider. 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.
