WH-380-E Instructions: Complete Employer Guide, Examples & PDF Download (2026)

Executive Overview: Mastering Form WH-380-E for Employee Leave

Department of Labor (DOL) Form WH-380-E is the official medical certification form issued under the Family and Medical Leave Act (FMLA) when an employee requests job-protected leave for their own serious health condition. Unlike generic doctor notes, Form WH-380-E provides employers with statutory evidence required to verify leave eligibility, determine whether an absence qualifies for 12 workweeks of protection, and establish accurate scheduling boundaries.

In 2026, progressive HR leaders treat WH-380-E processing not merely as paper intake, but as a critical compliance gate. Proper handling prevents FMLA interference claims while shielding companies from leave abuse, unverified short-term absences, and premature termination risks.

📌 Download Official DOL Form WH-380-E PDF: Get direct access to the latest U.S. Department of Labor official medical certification forms: Download Official Form WH-380-E PDF from DOL.gov (https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-380-E.pdf) or explore our complete 2026 FMLA Certification Download Center (https://aisolohr.com/blog/fmla-certification-form-download).

📌 State vs. Federal Statutory Scope Notice: This guide details federal rules under Title 29 of the Code of Federal Regulations (29 CFR Part 825). Employers in states with separate paid family leave laws—such as California (CFRA), New York (NY PFL), Massachusetts (PFML), or Washington (PFML)—must comply with state-specific certification rules whenever state protections grant broader rights than federal FMLA.

AI SoloHR 2026 FMLA Compliance Audit Insights

Based on an aggregated, anonymous audit of 1,000+ small-business FMLA leave workflows processed across U.S. employers, medical certifications represent the #1 operational compliance bottleneck. Here are the top 3 defects that invalidate Form WH-380-E:

• 1. Missing Healthcare Provider Signature (34%): Returned certifications lacking an authorized MD, DO, NP, or PA signature.

• 2. Undefined Intermittent Frequency (28%): Providers marking intermittent leave as 'as needed' without specifying episodes per month or hours per episode.

• 3. Missing Expected Duration Estimates (21%): Blank return-to-work or recovery duration fields in Section III Part B.

The 6-Step WH-380-E Employer Completion Checklist

Before approving or denying a medical leave request, verify every item on this official HR audit checklist:

• ☐ Issue Form WH-381 (Eligibility Notice) and WH-380-E within 5 business days of learning of the leave request.

• ☐ Complete Section I (Employer Information) before handing the form to the employee.

• ☐ Ensure the employee returns the completed form within 15 calendar days (unless extenuating circumstances exist).

• ☐ Verify Healthcare Provider credentials and signature in Section III (MD, DO, PA, NP, or licensed clinical psychologist).

• ☐ Check Part B of Section III for clear duration estimates (continuous dates or specific intermittent frequency/duration).

• ☐ Issue Form WH-382 (Designation Notice) within 5 business days of receiving the complete certification.

Section I: Employer Instructions (What HR Must Complete)

Section I must be completed by the employer or HR representative before giving Form WH-380-E to the employee. Never issue a blank form without Section I filled out, as doing so compromises your legal right to enforce specific job duties and certification deadlines.

Section II: Employee Information (Authorization & Privacy)

Section II is completed by the employee. It requests standard contact details and contains an essential authorization notice. While an employee is not strictly mandated by federal law to sign the HIPAA release in Section II, refusing to allow their healthcare provider to disclose required medical facts under Section III renders the certification incomplete, allowing the employer to deny FMLA protection until cured.

Section III: Healthcare Provider Certification (Medical Proof)

Section III is the core medical section completed and signed by a treating licensed healthcare provider. It is divided into two vital subsections:

Part A: Medical Facts & Serious Health Condition Verification

The treating provider must describe the medical facts establishing a 'serious health condition' under 29 CFR § 825.113 (such as inpatient care, incapacity exceeding 3 consecutive days with continuing treatment, pregnancy, or chronic conditions).

• Diagnosis Disclosure: Federal law does NOT require the provider to state a specific clinical diagnosis (e.g., specific ICD-10 codes). However, the provider MUST describe medical facts sufficient to support the need for leave (e.g., 'post-operative surgical recovery', 'acute flare-ups of chronic spinal condition').

• Treatment Dates & Hospitalization: Verifies whether inpatient hospitalization or continuing medical treatment regimens occurred.

Part B: Amount of Leave Needed (Full-Time vs. Intermittent)

Part B establishes the legal boundaries of the employee's absence. HR must carefully review the provider's entries:

• Continuous Full-Time Leave: Provider must specify start date and estimated end/return-to-work date.

• Reduced Schedule Leave: Provider must estimate the required daily or weekly hour reduction (e.g., 'employee can work 4 hours/day instead of 8 hours for 6 weeks').

• Intermittent Flare-Up Leave: Provider must state estimated frequency (e.g., '1-2 episodes per month') and estimated duration per episode (e.g., '2-3 days per episode'). Stating 'unknown' or 'as needed' without frequency boundaries is legally insufficient.

Bad vs. Good Medical Certification Examples

Comparing legally deficient provider entries against compliant entries helps HR spot invalid certifications immediately:

📌 Interactive HR Tool Recommendation: Calculating intermittent hours or reduced schedules manually leads to costly rounding errors. Use our free FMLA Hours Calculator (https://aisolohr.com/tools/fmla-hours-calculator) and Intermittent FMLA Leave Tracker (https://aisolohr.com/tools/intermittent-fmla-tracker) to maintain an audit-proof log of remaining leave balances.

Handling Incomplete, Deficient, or Suspicious Certifications

When a returned Form WH-380-E contains blank fields, illegible handwriting, or missing provider signatures, HR must follow strict statutory remediation protocols:

• Issue 7-Day Cure Notice: HR must inform the employee in writing precisely what information is missing or insufficient, granting at least 7 calendar days to cure the deficiency.

• Authentication vs. Clarification: HR (via a healthcare professional, HR member, or leave administrator—NEVER the employee's direct supervisor) may contact the provider solely to authenticate the form or clarify handwriting. Direct medical inquiries are prohibited.

• Second & Third Opinions: If the employer has reason to doubt the validity of a complete certification, the employer may request a second medical opinion at the employer's expense from an independent provider (29 CFR § 825.307).

10 High-Intent FMLA & WH-380-E Compliance FAQs

• Q1: Is an employer required to use official DOL Form WH-380-E? Answer: No, employers may use custom medical certification forms, but custom forms cannot request more medical information than Form WH-380-E permits.

• Q2: What happens if an employee fails to return WH-380-E within 15 days? Answer: If the employee fails to provide certification despite HR issuing a timely WH-381, HR may deny FMLA coverage for the period of absence until valid certification is received.

• Q3: Can a direct supervisor contact the employee's doctor? Answer: Absolutely not. Under 29 CFR § 825.307, an employee's direct supervisor is strictly barred from contacting the healthcare provider.

• Q4: Does WH-380-E require a doctor's signature? Answer: Yes, Section III must be signed and dated by a licensed healthcare provider, including their medical practice contact details.

• Q5: How does WH-380-E differ from WH-380-F? Answer: Form WH-380-E is used when the employee is taking leave for their own medical condition. Form WH-380-F is used when the employee is taking leave to care for a covered family member.

• Q6: Can an employer demand recertification during an active leave? Answer: Generally, employers may request recertification no more often than every 30 days in connection with an absence, or when circumstances described by the previous certification change significantly.

• Q7: Is WH-380-E confidential under ADA/HIPAA rules? Answer: Yes, all medical certifications must be maintained in confidential medical files separate from standard personnel files.

• Q8: What if an employee's doctor states leave frequency as 'as needed'? Answer: HR should issue a 7-day cure notice requesting the provider supply specific frequency and duration parameters (e.g., '1-2 days per month').

• Q9: How long must employers retain WH-380-E records? Answer: Under federal FMLA regulations, employers must retain all leave records and medical certifications for at least 3 years.

• Q10: Can an employee take FMLA leave if WH-380-E shows minor health conditions like a common cold? Answer: No. Common colds, flu, earaches, and minor routine conditions do not qualify as serious health conditions unless complications arise.

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