Get the free Form WH380E

CERTIFICATION OF HEALTH CARE PROVIDER FOR EMPLOYEES SERIOUS HEALTH CONDITION (FAMILY AND MEDICAL LEAVE ACT) OMB Control Number: 12350003 Form WH380E. Expires 2/28/2015 Section I: For Completion by

How to fill out form wh380e

Point by Point Guide on How to Fill Out Form WH-380E:

1. Obtain a copy of Form WH-380E: This form is also known as the "Certification of Health Care Provider for Employee’s Serious Health Condition." You can download the form from the official website of the U.S. Department of Labor or acquire it from your employer.
2. Identify the requester section: Fill out the top section of the form, providing your personal information such as your name, employee ID, job title, and contact details. This information will help to identify the individual requesting the certification.
3. Complete the employee information section: In this section, you will need to provide details about the employee who requires medical leave. Include their name, job position, and work location. Ensure that all information is accurate and up to date.
4. Specify the type of serious health condition: Check the appropriate box that indicates the type of serious health condition that the employee is experiencing. The options include their own condition, a family member's condition, or a covered servicemember's condition.
5. Document the medical certification: Provide the name and contact information of the health care provider responsible for assessing the employee's condition. In this section, you will need to attach any medical documentation or certification supporting the claim.
6. State the requested leave dates: Specify the anticipated duration of the employee's leave. Include the start and end dates, and provide a brief explanation of the condition and reasons for requesting leave. Ensure that the dates are reasonable and align with the medical certification.
7. Acknowledge employee rights and obligations: This section outlines the employee's rights and responsibilities during the leave period. Read it carefully to understand your entitlements and obligations as an employee.
8. Sign and date the form: Review all the information provided on the form, sign it, and date it. By signing the form, you certify that the information provided is accurate to the best of your knowledge.

Who Needs Form WH-380E?

Form WH-380E is typically required by employees who need to take leave under the Family and Medical Leave Act (FMLA). This form serves as a certification that verifies the need for medical leave due to an employee's own serious health condition or the serious health condition of their family member or a covered servicemember. It helps employers accurately assess and manage employees' eligibility for FMLA leave by gathering necessary medical information.

For pdfFiller’s FAQs

What is form wh380e?

Form WH-380-E is the Certification of Health Care Provider for Employee's Serious Health Condition.

Who is required to file form wh380e?

Employers are required to provide this form to employees who request leave under the Family and Medical Leave Act (FMLA).

How to fill out form wh380e?

The form must be completed by the employee's health care provider to certify the serious health condition of the employee.

What is the purpose of form wh380e?

The form is used to verify an employee's need for FMLA leave due to their own serious health condition.

What information must be reported on form wh380e?

The form must include information about the employee's health condition, treatment, and expected duration of the condition.

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