How to Fill Out and Submit the FMLA Medical Certification Form (WH-380-E/F)

The FMLA medical certification form is a Department of Labor template your healthcare provider completes to document a serious health condition that qualifies you, or a family member you care for, for job-protected leave. Most employees use one of two forms: WH-380-E for your own condition or WH-380-F when the condition belongs to a spouse, child, or parent. Both are free PDFs at dol.gov/agencies/whd/fmla/forms, and the completed form goes back to your employer, not to the Department of Labor.¹

Pick the Right Form First

Your employer may hand you the DOL form or a company version, but no version can ask for more information than the DOL form collects.

WH-380-E — your own serious health condition (surgery, chronic illness, pregnancy, any condition that keeps you from doing your job).²
WH-380-F — leave to care for a spouse, child, or parent with a serious health condition.³
WH-385, WH-385-V, WH-384 — military caregiver and qualifying exigency leave. These use different rules and paperwork; if your leave falls in that category, check the DOL forms page for the correct version.¹

Filling Out WH-380-E for Your Own Condition

Form WH-380-E has three sections. You or your employer handle Section I. Your healthcare provider handles the rest.²

Section I — Job and Employer Details

Section I captures your name, your employer’s name, the date, the return deadline, your job title, your regular schedule, and a statement of your essential job functions. If your employer attaches a written job description, check the box that says so. Otherwise, write a short summary of your core duties. Your provider will use this to explain how your condition affects the specific work you do, so it matters that the duties are accurate.

Section II, Part A — The Medical Basics

Your provider fills in their contact information and specialty, then completes Part A: the approximate date the condition started or will start, a best estimate of how long it will last, and which category of serious health condition applies. The form uses checkboxes for inpatient care, incapacity plus treatment, pregnancy, chronic conditions, permanent or long-term conditions, and conditions requiring multiple treatments.² Providers can include supporting facts like symptoms, diagnosis, and prescribed medications. Full diagnostic records are not required.

Section II, Part B — How Much Leave and What Kind

Part B is where certifications most often go wrong. Your provider must specify exactly how much time off you need and in what pattern. The fields cover:

Planned treatments (Field 5): dates of scheduled visits or procedures.
Referrals to other providers (Field 6): nature, start and end dates, and duration of referred treatment, including recovery.
Reduced schedule (Field 7): the reduced hours and the date range.
Continuous leave (Field 8): estimated start and end dates of an unbroken block off work.
Intermittent leave (Field 9): how often episodes will occur and how long each one will last.

The regulation requires enough detail to establish medical necessity for whatever schedule you request.⁴ Answers like “as needed” get certifications flagged as insufficient. Ask your provider for real numbers, such as “episodes occur approximately two to three times per month, lasting one to two days each.”

Section II, Part C — Which Job Functions You Can’t Do

Part C ties the medical picture back to Section I. Your provider identifies which of your essential job functions you cannot perform because of the condition. This is what justifies the leave: the point is not that you have a diagnosis, but that the diagnosis keeps you from doing your job.⁴ The provider then signs and dates.

Filling Out WH-380-F for a Family Member’s Condition

WH-380-F has the same structure with a different focus. Section I captures your information and identifies the family member. Section II, completed by the family member’s healthcare provider, covers the same medical territory: start date, probable duration, category of serious health condition, and supporting facts.³

The difference is what the provider must establish. Rather than showing you cannot perform your job, the certification must show that your family member needs care and estimate how often and for how long you need to be away to provide it.⁴ “Care” includes physical assistance, psychological comfort, and help with medical needs like transportation to appointments. For intermittent leave, the provider still needs to estimate episode frequency and duration.

Deadlines and the Cure Period

Your employer should request the certification within five business days of learning about your need for leave, or within five business days after unforeseeable leave begins.⁵ You then have at least 15 calendar days to return the completed form. If circumstances beyond your control make that impossible despite a good-faith effort, the deadline can be extended. Document why.

If the form comes back incomplete (missing entries) or insufficient (vague or non-responsive answers), your employer must tell you in writing exactly what is missing and give you at least seven calendar days to fix it.⁵ This cure period is a second chance. If the deficiencies still aren’t fixed after those seven days, your employer can deny FMLA leave. A form that is never returned at all counts as a failure to certify, and the cure process doesn’t apply.

How to Submit It

Return the completed form to your employer, not to the Department of Labor.¹ Hand delivery, certified mail with a return receipt, or a secure HR portal upload all work. Keep a signed and dated copy for yourself. If a dispute about the 15-day deadline comes up later, your copy is your proof.

You pay any fee your provider charges to complete the certification.⁶ Some providers roll the paperwork into a regular visit and some charge a separate administrative fee. Federal law does not cap what a provider can charge, so ask about the cost upfront.

What Your Employer Can Do After You Submit

Once your employer has enough information to decide, it has five business days to issue a Designation Notice (Form WH-382) stating that your leave is approved, not approved, or that more information is needed.⁷ If approved, the notice specifies how much of your 12-week FMLA entitlement (or 26-week entitlement for military caregiver leave) the leave will use, whether a fitness-for-duty certification will be required to return, and whether paid leave runs concurrently.⁸ Read it carefully. It is the official record of what your employer expects.

Even after a complete certification, your employer can contact your provider for two narrow purposes: clarification (understanding handwriting or the meaning of an answer) and authentication (confirming the provider actually signed the form).⁹ The employer cannot fish for additional medical information. Your direct supervisor is never allowed to make that call; only an HR professional, leave administrator, or other management official can.

If the employer has a genuine reason to doubt the certification, it can require a second medical opinion at its own expense. The employer picks the doctor, but that doctor cannot be someone the employer regularly employs or contracts with.⁹ The employer must reimburse reasonable out-of-pocket travel expenses and generally cannot send you outside your normal commuting distance.¹⁰ If the two opinions disagree, the employer can require a third opinion, also at its expense, from a provider you and the employer jointly agree on. That third opinion is final and binding. While any second or third opinion is pending, you remain provisionally entitled to FMLA benefits, including continued group health insurance.

Recertification for Ongoing Leave

If your leave stretches over weeks or months, your employer can periodically request a new certification. The general rule: no more often than every 30 days, and only in connection with an actual absence.¹¹ If your original certification listed a minimum duration longer than 30 days, the employer must wait until that period expires. Regardless of duration, an employer can request recertification every six months.¹²

Three situations let the employer ask sooner than 30 days:

You request an extension beyond what was originally certified.
Circumstances have changed significantly — the frequency, duration, or severity of absences no longer matches the original certification.
The employer receives information that casts doubt on your stated reason for the absence.

Recertification is at your expense unless your employer’s policy says otherwise. You still get at least 15 calendar days to provide it. Second and third opinions cannot be required on a recertification.¹¹

Fitness-for-Duty Before You Return

Your employer can require a fitness-for-duty certification as a condition of returning to work after FMLA leave for your own condition, but only if the same requirement applies to all similarly situated employees and the Designation Notice told you about it.¹³ The certification must relate only to the condition that caused the leave, not a general physical.

If the Designation Notice specified that the certification must address your ability to perform essential job functions, your employer should have provided a list of those functions with the notice. Your provider then certifies that you can perform them. You pay for this certification, and no second or third opinion can be required. Your employer can delay your return until you provide it, so schedule the appointment before your last day of leave to avoid a gap in pay.¹³

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
3
U.S. Department of Labor. Certification of Health Care Provider for Family Member’s Serious Health Condition
4
eCFR. 29 CFR 825.306 – Content of Medical Certification
5
eCFR. 29 CFR 825.305 – Certification, General Rule
6
U.S. Department of Labor. Information for Health Care Providers to Complete a Certification
7
U.S. Department of Labor. Designation Notice
8
Office of the Law Revision Counsel. 29 USC 2612 – Leave Requirement
9
eCFR. 29 CFR 825.307 – Authentication and Clarification of Medical Certification
10
U.S. Department of Labor. Family and Medical Leave Act Advisor
11
eCFR. 29 CFR 825.308 – Recertifications
12
U.S. Department of Labor. Family and Medical Leave Act Advisor
13
eCFR. 29 CFR 825.312 – Fitness-for-Duty Certification