U.S. · Employment · FMLA forms
FMLA form WH-380-E.
The certification of health care provider for an employee’s own serious health condition. Enter the request date to get the return and cure deadlines.
WH-380-E is the Department of Labor’s optional form for a health care provider to certify an employee’s own serious health condition. The employer decides whether to ask for it, and the employee gets it back to the employer within 15 calendar days of the request. If it is incomplete or insufficient, the employer must say in writing what is missing and allow seven calendar days to fix it. The form is optional: another form with the same basic information may be used.
Dates
Deadlines
What the form is
The Department of Labor publishes five optional-use certification forms for the Family and Medical Leave Act. WH-380-E is the one used when a leave request is due to the medical condition of the employee (the companion WH-380-F covers a family member’s condition). According to the DOL forms page, certification is an optional tool: an employer may require it to support leave, and the employee can give the information in any format, including a letter on the health care provider’s letterhead. Employers may use their own forms if they carry the same basic information. The regulation says so itself: Form WH-380-E, or another form containing the same basic information, may be used, but no information may be required beyond what 825.306, 825.307 and 825.308 specify (825.306(b)).
Who is involved
The form is addressed to the health care provider, who supplies the medical information. The regulation lets the employer, when requesting certification, attach a statement of the essential functions of the employee’s position for the provider to review (825.123(b)), and a sufficient certification must say which functions the employee cannot perform. The employee is responsible for getting the completed form to the employer, and for giving the provider any authorization needed to release the information. The employee may be asked, but cannot be required, to authorize the provider to talk to the employer directly (825.306(e)). The DOL asks that completed forms never be sent to the Department; they go back to the employee, who gives them to the employer.
What a provider may be asked
Under 825.306(a), the employer may require the provider’s name, address, telephone and fax number and type of practice; the approximate date the condition began and its probable duration; a statement of the medical facts sufficient to support the need for leave, which may include symptoms, diagnosis, hospitalization, visits, medication and referrals; and information sufficient to show the employee cannot perform the essential functions of the job, the nature of other work restrictions and the likely duration. When leave is intermittent or on a reduced schedule, the form must also establish medical necessity and estimate the dates, frequency or duration of treatment, recovery or episodes. Everything must relate only to the serious health condition for which the current leave is needed.
Timing, step by step
| Step | Timing | Section |
|---|---|---|
| Employer asks for certification | Ordinarily when the employee gives notice, or within 5 business days after; for unforeseen leave, within 5 business days after leave starts. Later if the employer has reason to question the leave | 825.305(b) |
| Employee returns the form | 15 calendar days after the request, unless not practicable despite diligent, good faith efforts, or the employer allows more time | 825.305(b) |
| Employer says the form is incomplete or insufficient | In writing, stating what additional information is necessary | 825.305(c) |
| Employee cures | 7 calendar days (unless not practicable despite diligent good faith efforts) | 825.305(c) |
| If still deficient or never returned | Employer may deny the taking of FMLA leave | 825.305(d), 825.313 |
A form is incomplete if one or more applicable entries are blank. It is insufficient if it is complete but vague, ambiguous or non-responsive. A form that is never returned is neither; it is a failure to provide certification.
Limits on the employer
If a complete and sufficient certification signed by the provider is submitted, the employer may not ask the provider for more information. It may contact the provider only for clarification and authentication, after giving the employee the chance to cure, and the contact must come from a health care provider, a human resources professional, a leave administrator or a management official, never the employee’s direct supervisor (825.307(a)). Authentication means asking whether the provider completed or authorized the form; clarification means understanding handwriting or a response. If the employer doubts the validity of a certification, it may require a second opinion at its own expense, and a third opinion if the first two differ.
Worked example
An employee tells her manager on Monday, November 2, 2026 that she needs surgery. Five business days later is Monday, November 9, the usual outer limit for the request. The employer asks on Wednesday, November 4. The completed WH-380-E is due 15 calendar days later, Thursday, November 19. If the form comes back on November 12 with the dates of incapacity left blank and the employer writes on November 13 asking for them, the employee has until Friday, November 20 to cure.
About the expiration date on the form
The DOL answers directly that an expired OMB date printed on its forms does not matter for content: the content of the information is still applicable, and the expiration date relates to the paperwork collection approval. An employer must also accept a complete and sufficient certification in any format, including a fax, a copy, or a letter on the provider’s letterhead, rather than rejecting it because it is not on the company form.
Sources
Sources opened and read November 2, 2026.
- U.S. Department of Labor: FMLA forms page (Internet Archive copy; dol.gov returns 403 to automated requests) (read November 2, 2026)
- eCFR: 29 CFR 825.305 Certification, general rule (current through October 29, 2026) (read November 2, 2026)
- eCFR: 29 CFR 825.306 Content of medical certification (current through October 29, 2026) (read November 2, 2026)
- eCFR: 29 CFR 825.307 Authentication and clarification; second and third opinions (current through October 29, 2026) (read November 2, 2026)
Frequently asked questions
What is FMLA form WH-380-E?
The Department of Labor’s optional-use Certification of Health Care Provider for an employee’s own serious health condition. WH-380-F is the matching form for a family member’s serious health condition.
Is WH-380-E mandatory?
No. Employers may require certification, but may use WH-380-E or another form containing the same basic information, and an employee can supply the information in any format. No information beyond 29 CFR 825.306 to 825.308 may be required.
How long does an employee have to return the FMLA medical certification?
15 calendar days after the employer’s request, unless that is not practicable despite diligent, good faith efforts or the employer gives more time (825.305(b)).
What if the WH-380-E is incomplete?
The employer must state in writing what additional information is needed and give the employee seven calendar days to cure the deficiency. If it is not cured, the employer may deny the taking of FMLA leave (825.305(c)-(d)).
Can my employer call my doctor about the form?
Only to clarify or authenticate a complete and sufficient form, after giving you the chance to cure, and through a health care provider, HR professional, leave administrator or management official, never your direct supervisor (825.307(a)). You cannot be required to sign a release.
Do I send the completed form to the Department of Labor?
No. The DOL asks that completed certification forms not be sent to its Wage and Hour Division; return them to the employee to give to the employer.
Does the expiration date printed on the form matter?
No. The DOL states the expiration date relates to Office of Management and Budget approval of the information collection, and the content of the form is still applicable after it passes.
Not legal or compliance advice
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