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CLEAR FORM Certification of Health Care Provider for Employees Serious Health Condition under the Family and Medical Leave Act. S. Department of Labor Wage and Hour Division DO NOT SEND COMPLETED

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How to fill out wh-380epdf

01

Download the WH-380E form in PDF format.

02

Open the PDF form using a compatible PDF reader.

03

Begin by providing your personal information such as name, address, and contact details.

04

Fill in the employee information section, including the name of the employee and their position.

05

Specify the relevant dates including the start and end date of the leave.

06

Select the type of leave being requested from the given options.

07

Indicate whether the leave is continuous or intermittent.

08

Ensure to provide any additional required information or documentation as necessary.

09

Review the completed form for accuracy and completeness.

10

Sign and date the form. If applicable, provide the employer or healthcare provider sections for completion.

11

Make a copy of the filled-out WH-380E form for your records.

12

Submit the completed form to the appropriate recipient as per the instructions provided.

Who needs wh-380epdf?

01

The WH-380E form, also known as the Certification of Health Care Provider for Employee's Serious Health Condition, is needed by employees who require leave under the Family and Medical Leave Act (FMLA).

02

This form is typically used when an employee or an eligible family member of the employee has a serious health condition that requires medical care or treatment.

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What is wh-380epdf?

wh-380epdf is a form used for certification of health care provider for employee's serious health condition under the Family and Medical Leave Act (FMLA).

Who is required to file wh-380epdf?

Employers are required to file wh-380epdf when an employee requests leave for a serious health condition under FMLA.

How to fill out wh-380epdf?

wh-380epdf should be filled out by the employee's health care provider and then submitted to the employer.

What is the purpose of wh-380epdf?

The purpose of wh-380epdf is to provide certification of an employee's serious health condition and support the need for FMLA leave.

What information must be reported on wh-380epdf?

wh-380epdf must include the employee's health condition, treatment plan, expected duration of leave, and any other relevant medical information.

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