To complete FMLA forms WH-380-E and WH-380-F, you fill in the identifying information at the top, hand the form to the treating healthcare provider so they can complete the medical sections, and return the signed form to your employer within 15 calendar days of the certification request. WH-380-E documents your own serious health condition; WH-380-F documents a family member’s. Both are optional-use forms published by the U.S. Department of Labor’s Wage and Hour Division and are free to download in English or Spanish.1U.S. Department of Labor. FMLA: Forms
Which Form You Need
Use WH-380-E when the person with the serious health condition is you. Use WH-380-F when the person with the condition is a spouse, child, or parent you need to care for; in that case, the family member’s healthcare provider completes the medical sections, not yours.2U.S. Department of Labor. Certification of Health Care Provider for Family Member’s Serious Health Condition Under the Family and Medical Leave Act
Your employer may hand you a company-designed certification instead of the DOL form. That’s allowed, as long as the employer’s version collects the same information and asks for nothing beyond what the FMLA regulations permit. If you return a complete DOL form, your employer must accept it and cannot reject it for being on the wrong template.1U.S. Department of Labor. FMLA: Forms
Section I: Employee and Employer Information
Section I is the identifying block at the top of the form. Either you or your employer can complete it. It asks for your name, the name of the person with the serious health condition (you on WH-380-E, your family member on WH-380-F), and your employer’s name.3U.S. Department of Labor. Certification of Health Care Provider for Employee’s Serious Health Condition Under the Family and Medical Leave Act
If your employer gives you the form with Section I already filled in, read it. Check the spelling of names and confirm the family member’s relationship to you is correct on WH-380-F. Anything wrong here can slow the decision later. If Section I is blank, fill it in yourself before handing the form to the provider so the medical office isn’t guessing about who the paperwork is for.
Section II: What the Healthcare Provider Completes
The healthcare provider fills out the rest of the form. The FMLA regulations set out exactly what a valid medical certification must contain, and the form walks the provider through those items in order.4eCFR. 29 CFR 825.306 – Content of Medical Certification
Both forms open with the provider’s contact block: name, business address, phone, fax, and the type of medical practice or specialization. Then come the substantive parts.
Part A: Medical Facts About the Condition
Part A asks the provider for the approximate date the condition started (or will start), an estimate of how long it will last, and the category of serious health condition that applies. The regulation recognizes six categories: inpatient care, pregnancy, a chronic condition, permanent or long-term incapacity, incapacity plus treatment, and conditions requiring multiple treatments. The provider marks the category that fits and gives a brief factual description of the medical situation.
Part B: Amount of Leave Needed
Part B translates the diagnosis into a leave request. The provider identifies scheduled treatment dates, notes any referrals to other providers, and answers whether a reduced work schedule is medically necessary. If the leave will be continuous, the provider gives an expected duration. If the leave will be intermittent, the provider gives an estimated frequency of episodes and how long a typical episode lasts. Vague answers here are the ones most likely to come back marked insufficient, so ask the provider to give numbers where the form asks for numbers.
Part C: Essential Job Functions (WH-380-E Only)
Part C appears on WH-380-E and not on WH-380-F, because it asks whether the condition prevents the employee from performing one or more essential functions of the job. If your employer provided you with a list of your essential job functions, give that list to the provider along with the form. The provider then identifies which functions you can’t perform and confirms that inability with a signature.
The provider signs and dates the form at the end. An unsigned certification isn’t a valid certification.
The Mistakes That Get Forms Rejected
Two problems account for most rejected certifications: blank entries and vague answers. The regulations call the first “incomplete” and the second “insufficient,” and the distinction matters because your employer must tell you in writing which one applies and what’s needed to fix it.5U.S. Department of Labor. Designation Notice
Before the form leaves the medical office, check every field. If a question doesn’t apply, ask the provider to write “N/A” rather than leave the line empty. A blank line reads as a missed question; “N/A” reads as an answered one. If an answer is a number, make sure a number is there. If an answer is a date range, make sure both endpoints are there.
Returning the Form: The 15-Day Deadline
You have 15 calendar days from the date your employer requests certification to return the completed form. Your employer can give you longer, but not shorter. If you made a genuine effort to meet the deadline and couldn’t, because the doctor’s office had no available appointments for example, you’re entitled to additional time as long as you can show you acted in good faith.6eCFR. 29 CFR 825.305 – Certification, General Rule
Submit the form by whatever method your employer accepts: hand delivery, certified mail, fax, or a secure HR portal. Keep proof of when you submitted it. A delivery receipt, a fax confirmation page, or a screenshot of your portal upload is enough. If a dispute comes up later over whether you met the deadline, that record is what protects you.
If you never return a certification, or you return one that stays incomplete or insufficient after you’ve had a chance to fix it, your employer can deny FMLA protection for the absence.6eCFR. 29 CFR 825.305 – Certification, General Rule
If Your Employer Says the Form Is Incomplete or Insufficient
Your employer must tell you in writing exactly what’s missing or unclear. Once you get that notice, you have at least seven calendar days to cure the problem, unless circumstances genuinely make that impossible despite your best efforts. Take the notice back to the provider, get the specific items addressed, and resubmit. A generic “try again” from your employer doesn’t satisfy the regulation, so if you receive one, ask for the specifics in writing.6eCFR. 29 CFR 825.305 – Certification, General Rule
Who Pays for the Doctor’s Visit
You do. The cost of the appointment where the provider completes the initial certification, and any later recertifications, comes out of your pocket or is billed through your insurance. Your employer is only responsible for the cost of a second or third opinion if it requires one.7U.S. Department of Labor. Information for Health Care Providers to Complete a Certification
What Happens to the Form After You Turn It In
FMLA medical certifications carry sensitive health information, and the regulations require your employer to keep them as confidential medical records in files separate from your regular personnel file. That separation is also consistent with the confidentiality rules under the Americans with Disabilities Act and the Genetic Information Nondiscrimination Act where those laws apply.8U.S. Department of Labor. Fact Sheet #28G: Medical Certification Under the Family and Medical Leave Act
A manager pulling your personnel file should not see your completed WH-380-E or WH-380-F. If you learn the two are being stored together, that’s a compliance issue worth raising with HR or, if it isn’t resolved, with the DOL’s Wage and Hour Division.