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Certification of Health Care Provider for Employees Serious Health Condition (Family and Medical Leave Act)U.S. Department of Labor Wage and Hour Division DO NOT SEND COMPLETED FORM TO THE DEPARTMENT

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How to fill out fmla-wh-380-employee-serious-healthpdf

01

To fill out the FMLA-WH-380 Employee's Serious Health Condition Certification form, follow these steps:

02

Start by downloading the FMLA-WH-380 form in PDF format from the official website.

03

Open the downloaded form using a compatible PDF viewer on your computer.

04

Read the instructions provided at the beginning of the form to understand the purpose and requirements.

05

Begin by entering your personal information in the designated fields, such as your name, employee ID, and contact details.

06

Next, provide the name and contact information of your healthcare provider who can certify your serious health condition.

07

Carefully review the certification requirements and ensure all the necessary information is correctly filled out.

08

Answer the questions related to your health condition, providing accurate and detailed information.

09

If required, attach any supporting medical documents or reports to substantiate your condition.

10

Review the completed form for any errors or missing information.

11

Sign and date the certification form to indicate your consent and understanding.

12

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

13

Submit the original form to your employer as per the designated procedure or provide it to the applicable department.

Who needs fmla-wh-380-employee-serious-healthpdf?

01

FMLA-WH-380 Employee's Serious Health Condition Certification form is needed by employees who have a serious health condition and require leave under the Family and Medical Leave Act (FMLA). This form is used to document the employee's health condition and provide necessary certification to their employer for FMLA leave eligibility.

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What is fmla-wh-380-employee-serious-healthpdf?

FMLA WH-380 Employee Serious Health Care Provider form is a document used under the Family and Medical Leave Act (FMLA) to certify an employee's serious health condition.

Who is required to file fmla-wh-380-employee-serious-healthpdf?

Employees seeking FMLA leave due to their own serious health condition or to care for a family member with a serious health condition are required to file this form.

How to fill out fmla-wh-380-employee-serious-healthpdf?

To fill out the form, the employee must complete sections regarding their personal information, the healthcare provider’s details, and the medical condition description as required by the form.

What is the purpose of fmla-wh-380-employee-serious-healthpdf?

The purpose of the fmla-wh-380 is to provide verification of an employee’s serious health condition to support their request for FMLA leave.

What information must be reported on fmla-wh-380-employee-serious-healthpdf?

The form requires information about the employee, the healthcare provider, the medical condition, the dates of treatment, and any need for continued leave.

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