How to Fill Out FMLA Paperwork for Mental Health Conditions

To request FMLA leave for a mental health condition such as major depression, an anxiety disorder, or PTSD, you and your healthcare provider complete Form WH-380-E, the Department of Labor’s Certification of Health Care Provider for Employee’s Serious Health Condition. The form has three sections filled out by three different people: your employer describes your job, you identify yourself and the reason for leave, and your treating provider documents the medical facts that connect your condition to the duties you cannot perform. You have 15 calendar days from the date your employer requests the certification to return it completed.¹

Confirm You’re Eligible Before Starting the Form

Paperwork only helps if you qualify. Three federal tests apply: at least 12 months of employment with your current employer (not necessarily consecutive), at least 1,250 hours of actual work in the 12 months immediately before leave begins, and a worksite with at least 50 employees within a 75-mile radius.²

Your condition must also meet the FMLA definition of a “serious health condition,” which for mental health generally means either inpatient care (a hospital stay or admission to a residential treatment facility) or continuing treatment by a healthcare provider.³ A chronic condition qualifies if it continues over an extended period, may cause episodic flare-ups, and requires at least two provider visits per year.⁴ Recurring major depressive episodes, panic disorder, and bipolar disorder are commonly documented this way. Everyday stress or short-term sadness without ongoing treatment does not meet the standard.

If your employer is too small for FMLA to apply, the Americans with Disabilities Act may still require a reasonable accommodation, which can include leave. The paperwork is different, so ask HR.

Where to Get Form WH-380-E

Download WH-380-E from the DOL’s Wage and Hour Division website, or ask your HR department for a copy.⁵ Your employer may use its own equivalent form; either version must contain the same categories of information the regulation requires.⁶

Before your provider fills anything in, notify your employer of the need for leave. If the need is foreseeable, give at least 30 days’ notice; if it isn’t, notify them as soon as practical.⁷ You don’t have to say the words “FMLA.” You do have to give enough information for your employer to recognize the absence may qualify—typically, that you need time off for treatment of a serious medical condition. Your employer’s request for certification is what starts your 15-day clock.

Section I: Filled Out by Your Employer

Your employer completes Section I, which identifies you and lists the essential functions of your job. Read this part before you hand the form to your provider. The provider’s medical explanation in Section III has to line up with these specific duties, so if the job functions look incomplete or inaccurate, raise it with HR before the form leaves your hands. A cashier’s “regular attendance and customer interaction” and a software engineer’s “sustained concentration and complex problem-solving” call for different clinical language downstream.

Section II: Filled Out by You

Section II covers your name, contact information, and the reason for leave. The useful move here is to describe how your condition affects the job duties listed in Section I, not just how you feel. Compare two versions:

Weak: “I can’t work because of anxiety.”
Stronger: “During acute episodes I cannot maintain sustained concentration, handle high-stress client calls, or reliably attend scheduled shifts.”

The stronger version mirrors the essential-functions language your employer wrote in Section I and gives your provider a template to build on in Section III.

Section III: Filled Out by Your Healthcare Provider

Your treating provider—psychiatrist, psychologist, licensed clinical social worker, or another qualified professional—completes Section III. This is the heart of the certification. It asks for the date the condition began, the probable duration of the condition or treatment, and the medical facts that support the need for leave. Those facts can describe symptoms such as severe insomnia, panic attacks, inability to concentrate, or suicidal ideation.

You Do Not Have to Disclose a Diagnosis

A specific clinical diagnosis may be included, but the form itself states it is not required.⁵ Your provider can instead describe functional limitations—for example, “patient experiences recurring episodes of severe incapacity lasting one to three days, during which patient cannot maintain concentration or regular attendance.” If privacy matters to you, tell your provider before the appointment that you’d like them to use functional language rather than naming the diagnosis. What the form does require is that the medical facts connect clearly to the job functions in Section I.

If You Need Intermittent Leave, Give Real Numbers

Mental health conditions often flare unpredictably rather than requiring a single continuous block off. FMLA allows intermittent leave—taking your 12 weeks in smaller pieces—when medically necessary.⁶ That might look like two or three days off during a depressive episode, leaving early for therapy, or a reduced schedule during intensive outpatient treatment.

For intermittent leave, your provider must estimate frequency and duration in the space provided. Write specifics: “approximately two episodes per month, each lasting one to three days.” Answers like “as needed” or “variable” invite your employer to challenge individual absences or send the form back as insufficient, which delays approval.

Check Every Field Before You Submit

A blank box or a missing signature is enough for your employer to treat the certification as incomplete. Go through each question, confirm your provider signed and dated, and confirm every field you’re responsible for is filled.

Submitting the Form and Fixing Problems

Deliver the completed form to HR or your employer’s third-party leave administrator within 15 calendar days of the employer’s request. Use a method that creates a record of when you sent it—email with a read receipt, certified mail, or an HR portal that timestamps submissions. If a genuine obstacle prevents you from meeting the deadline despite good-faith effort, such as your provider being unable to schedule you in time, the regulation allows some flexibility, but document your efforts.¹

Within five business days of receiving your certification, your employer must give you a written Designation Notice (Form WH-382) telling you whether the leave is approved and how much of your 12-week entitlement it will use.⁸

If your employer flags the certification as incomplete (blank fields) or insufficient (vague or unclear answers), they must tell you in writing exactly what’s missing, and you get at least seven calendar days to fix it.¹ Uncorrected deficiencies can lead to denial of FMLA protection, so respond promptly. If your employer doubts the certification’s validity, they may pay for a second opinion from a provider they choose (but not one they regularly use), and, if second and first opinions conflict, a jointly agreed-on third provider whose opinion is final.⁹

Who Can See What You Wrote

FMLA medical certifications must be kept in confidential files, separate from your regular personnel file.¹⁰ Only an HR professional, leave administrator, management official, or the employer’s own healthcare provider may contact your provider to authenticate the signature or clarify unclear answers—your direct supervisor cannot.⁹ During authentication, no new medical information can be requested. Combined with your right to skip the diagnosis, this lets you satisfy the paperwork while sharing only what’s medically necessary.

Practical Tips for Getting the Form Right the First Time

Book a dedicated appointment to complete the form. Bring the version with Section I already filled in so your provider can see the specific duties to address.
Match Section III to Section I. If Section I lists “sustained concentration” and “regular attendance,” your provider’s answers should speak to those functions directly.
Use numbers for intermittent leave. Episodes per month, days per episode, appointments per week—concrete estimates hold up; “as needed” doesn’t.
Keep copies of everything: the completed form, submission receipts, and every written communication from your employer about the leave.
If a diagnosis feels too personal, ask your provider to describe functional limits instead. The form allows it.
If the form comes back as insufficient, treat the seven-day cure window as a hard deadline. Get back to your provider the same day.

1
eCFR. 29 CFR 825.305 – Certification, General Rule
2
eCFR. 29 CFR 825.110 – Eligible Employee
3
eCFR. 29 CFR 825.113 – Serious Health Condition
4
eCFR. 29 CFR 825.115 – Continuing Treatment
5
U.S. Department of Labor (DOL.gov). Certification of Health Care Provider for Employees Serious Health Condition Under the Family and Medical Leave Act
6
eCFR. 29 CFR 825.306 – Content of Medical Certification
7
U.S. Department of Labor. Fact Sheet 28E – Requesting Leave Under the Family and Medical Leave Act
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U.S. Department of Labor. Fact Sheet 28D – Employer Notification Requirements Under the Family and Medical Leave Act
9
eCFR. 29 CFR 825.307 – Authentication and Clarification of Medical Certification; Second and Third Opinions
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U.S. Department of Labor. Family and Medical Leave Act Advisor – Recordkeeping Requirements