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For FMLA purposes, a “serious health condition” means an illness, injury, impairment, or physical or mental condition that involves inpatient care or continuing treatment by a health care provider. For more information about the definitions of a serious health condition under the FMLA, see the chart on page 4.
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Jun 1, 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. Form Wh-380-e Is Often Used In Serious Health Condition, U.s. Department Of Labor - Wage And Hour Division, Health Care ...
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INSTRUCTIONS to the EMPLOYER: 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.
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WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition (Family and Medical Leave Act) To obtain this form go to http://www.dol.gov/esa/whd/forms/WH-380-E.pdf
Page 1 of 4 Form WH-380-E, Revised June 2020 . U.S. Department of Labor Wage and Hour Division Certification of Health Care Provider for Employee’s Serious Health Condition under the Family and Medical Leave Act. DO NOT SEND COMPLETED FORM TO THE DEPARTMENT OF LABOR. RETURN TO THE PATIENT. OMB Control Number: 1235-0003 Expires: 6/30/2023
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.
