How to Fill Out and Submit FMLA Form WH-380-E: Sections and Deadline

To use FMLA Form WH-380-E, your employer completes Section I with your job information, you fill in Section II with your name and your provider’s name, your healthcare provider completes Section III with the medical facts supporting your need for leave, and you return the signed form to your employer within 15 calendar days of the request. The form is the Department of Labor’s standard medical certification for an employee’s own serious health condition, and you can download it at dol.gov/agencies/whd/fmla/forms or use the copy your employer gives you when they request certification.¹

One boundary to note before you start. This form covers your own medical condition only. If you need leave to care for a spouse, child, or parent, the correct form is WH-380-F, and separate forms exist for military caregiver leave and qualifying exigency leave.¹

The Three Sections and Who Fills Out Each

The form is divided so that no single person completes it end to end. Skipping fields or leaving vague answers is the fastest way to get the form kicked back, so treat completeness as the goal from the start.

Section I: Employer

Your employer (usually HR or a leave administrator) fills this section out before handing the form to you. It captures the employer’s name and contact information, your job title, and a description of your essential job functions.² A checkbox indicates whether a full written job description is attached. If your employer does not attach one, ask for it. Your provider needs to understand what your job physically and mentally demands before they can say whether you can perform it. Vague descriptions lead to vague medical opinions, which employers flag as insufficient.

Section II: Employee

You fill in your name and the name of your healthcare provider. That is the whole section. It also carries a Genetic Information Nondiscrimination Act safe harbor notice directing the provider not to include information about genetic tests or the manifestation of disease in your family members.² You do not need to act on that notice; it is there for the provider.

Section III: Healthcare Provider

This is where most problems occur. Bring the completed Section I with the job description to your appointment so the provider can tailor their answers to what your job actually requires. The information they supply must meet the content requirements set out in federal regulations.³

The provider needs to address, at minimum:

Their contact information, including the type of medical practice or specialization.
The approximate date the condition began and how long it is expected to last.
Enough medical facts (symptoms, hospitalization, prescribed medication, referrals) to support the need for leave. The provider does not have to disclose a specific diagnosis if sufficient facts are given, but statements like “patient is under my care” are not enough.
Which essential job functions you cannot perform, along with any work restrictions and how long they will last.
If you will not be out continuously, why intermittent or reduced-schedule leave is medically necessary, along with an estimate of how often episodes will occur and how long each will last. Employers rely heavily on these numbers for scheduling, so a concrete estimate (“1–2 times per month, lasting 1–2 days”) works better than open-ended answers.

The provider signs and dates the form. An unsigned certification is treated as incomplete.

Review Before You Submit

Before you send the form back, read it yourself. Check that every question has an answer, every date is filled in, the signature block is complete, and the intermittent-leave frequency and duration are not left blank. Common deficiencies employers cite include “unknown” duration, blank frequency estimates, and no clear link between the condition and specific job functions you cannot perform.

The 15-Day Deadline

Once your employer requests the certification, you have 15 calendar days to return it.⁴ The clock starts when the employer makes the request, not when your provider appointment happens. If completing the form within 15 days is genuinely not possible despite your good-faith efforts, document those efforts. The regulation gives some leeway for extenuating circumstances, but you have to be able to show you tried.⁵

Submit however your employer accepts it: hand delivery, certified mail, fax, email, or a leave-management portal. Keep proof of delivery. If you hand it to someone in person, get a date-stamped, signed copy. If a dispute arises later about whether you met the deadline, that receipt is your evidence.

Missing the window has real consequences. Your employer can deny FMLA protection for the absence, which means the time away may be treated as unexcused under the company’s attendance policy and could lead to discipline or termination.⁶

What If the Form Comes Back Incomplete

If your employer finds the certification is missing entries or too vague, they must tell you in writing exactly what is deficient. You then get at least seven calendar days to fix it.⁴ This is your cure period. If you do not fix the identified problems within those seven days, your employer can deny FMLA leave entirely.⁷

When Your Employer Can Question the Certification

After receiving a complete form, your employer has limited tools to verify it.

Authentication means sending a copy to your provider and asking whether the provider actually completed it. Clarification means contacting the provider to decipher handwriting or understand a specific response. In both cases, only an HR professional, leave administrator, management official, or another healthcare provider can make the call. Your direct supervisor is specifically prohibited from contacting your doctor, and the employer cannot request medical records or information beyond what the form itself asks.⁸

If your employer has reason to doubt the certification, they can require a second opinion from a different provider. The employer pays and picks the provider, but that provider cannot be someone the company regularly employs or contracts with. While you wait for the second opinion, you remain provisionally entitled to FMLA benefits, including continuation of group health coverage. If the first and second opinions disagree, a third opinion can be required, again at the employer’s expense. You and the employer must jointly agree on the third provider, and that provider’s determination is final and binding.⁹

Recertification Later On

Your initial WH-380-E does not last forever. Employers can request a fresh version of the form under specific timing rules.¹⁰ The standard interval is no more than once every 30 days, and only in connection with an actual absence. If your certification lists a minimum duration longer than 30 days, the employer must wait until that period expires, though they can always request recertification every six months regardless. Earlier requests are allowed if you ask to extend your leave, if the frequency or duration of your absences significantly exceeds what the certification estimated, or if the employer receives information casting doubt on the reason for the absence.

The same 15-day return window applies to recertifications, and the same consequences follow if you miss it. Treat each request with the urgency of the original.

1
U.S. Department of Labor. FMLA Forms
2
U.S. Department of Labor. Certification of Health Care Provider for Employee’s Serious Health Condition Under the Family and Medical Leave Act
3
eCFR. 29 CFR 825.306 – Content of Medical Certification
4
eCFR. 29 CFR 825.305 – Certification Timing and Requirements
5
U.S. Department of Labor. Family and Medical Leave Act Advisor – Timing
6
eCFR. 29 CFR 825.313 – Failure To Provide Certification
7
U.S. Department of Labor. Fact Sheet 28G – Medical Certification Under the Family and Medical Leave Act
8
eCFR. 29 CFR 825.307 – Authentication and Clarification of Medical Certification
9
U.S. Department of Labor. Family and Medical Leave Act Advisor – Second Opinion
10
eCFR. 29 CFR 825.308 – Recertification