What is the purpose of the WH‑380‑E form?

The WH‑380‑E certifies that an employee’s serious health condition (or a family member’s condition) meets the eligibility criteria for FMLA leave.

Can I fill out WH‑380‑E on a mobile device?

Yes. The Formize PDF Filler works on smartphones and tablets, allowing you to complete the form on any modern browser.

Do I need to include a diagnosis on the form?

A diagnosis is optional unless your employer specifically requests it. The form’s instructions note that the provider may omit the diagnosis while still meeting FMLA requirements.

How many copies of the completed WH‑380‑E do I need?

Typically one completed, signed copy is submitted to HR. Keep a personal copy for your records.

Is the WH‑380‑E required for all FMLA leave types?

The form is required for serious health conditions of the employee or an immediate family member. Separate certification forms exist for newborn or adopted child care.

What if I make a mistake after submitting the form?

Contact your HR department immediately. You can submit a corrected WH‑380‑E with a note explaining the changes.

Is the WH‑380‑E a federal or state form?

It is a federal form issued under the Family and Medical Leave Act, but many states adopt the same version for their own leave programs.

Do I need a notary for the WH‑380‑E?

No. The health‑care provider’s signature and date satisfy the certification requirements.

WH‑380‑E Fillable PDF – Family & Medical Leave Act Medical Certification

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WH‑380‑E Fillable PDF – Family & Medical Leave Act Medical Certification

The WH‑380‑E is the official certification of a health care provider required under the Family and Medical Leave Act (FMLA). Employers use this form to verify an employee’s serious health condition, a newborn or newly‑adopted child, or a need for caretaker leave.

What Is the WH‑380‑E Form?

This government‑issued PDF collects detailed medical information, including diagnosis, treatment dates, and the provider’s certification that the condition qualifies for FMLA leave. It is used by federal, state, and private employers across the United States.

How to Complete the WH‑380‑E Online

Instead of downloading and editing the PDF in a separate editor, simply click the “Fill out this form” button on this page. The Formize PDF Filler app will load the fillable version instantly. Follow these steps:

Step 1: Click the “Fill out this form” button.
Step 2: The Formize filler loads – the document becomes interactive.
Step 3: Enter the employee’s information, health‑care provider details, and medical certification data.
Step 4: Review for completeness and accuracy.
Step 5: Click “Save & Download” to obtain a completed PDF you can print or email to HR.

Common Mistakes to Avoid

Leaving any required field blank – every asterisk (*) field must be completed.
Providing a diagnosis when the form states it is optional (unless your employer requests it).
Using illegible handwriting – the online filler ensures clear, typed text.
Submitting the form without the provider’s signature and date.

Where to Submit the Certified Form

After saving the completed WH‑380‑E, send it to your employer’s Human Resources or Benefits department according to your company’s leave‑request policy. Federal employees may also submit it to the agency’s HR office.

Download the Fillable WH‑380‑E PDF

If you prefer to keep a copy of the original document, you can download the official WH‑380‑E PDF from the West Virginia Legislature site. Our online filler uses the same version, guaranteeing compliance.

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FAQ

What is the purpose of the WH‑380‑E form?
The WH‑380‑E certifies that an employee’s serious health condition (or a family member’s condition) meets the eligibility criteria for FMLA leave.
Can I fill out WH‑380‑E on a mobile device?
Yes. The Formize PDF Filler works on smartphones and tablets, allowing you to complete the form on any modern browser.
Do I need to include a diagnosis on the form?
A diagnosis is optional unless your employer specifically requests it. The form’s instructions note that the provider may omit the diagnosis while still meeting FMLA requirements.
How many copies of the completed WH‑380‑E do I need?
Typically one completed, signed copy is submitted to HR. Keep a personal copy for your records.
Is the WH‑380‑E required for all FMLA leave types?
The form is required for serious health conditions of the employee or an immediate family member. Separate certification forms exist for newborn or adopted child care.
What if I make a mistake after submitting the form?
Contact your HR department immediately. You can submit a corrected WH‑380‑E with a note explaining the changes.
Is the WH‑380‑E a federal or state form?
It is a federal form issued under the Family and Medical Leave Act, but many states adopt the same version for their own leave programs.
Do I need a notary for the WH‑380‑E?
No. The health‑care provider’s signature and date satisfy the certification requirements.

HVORDAN

Sådan udfylder du WH-380-E gratis online i 5 nemme trin:

1
Open the Fillable Form
Click the “Fill out this form” button on the page. The Formize PDF Filler loads the WH‑380‑E as an interactive document.
2
Enter Required Information
Type the employee’s name, dates of care, and the health‑care provider’s details into the highlighted fields.
3
Complete the Medical Certification
Provide the diagnosis (if required), treatment plan, and any functional limitations. Ensure the provider signs and dates the form.
4
Review and Save
Double‑check all entries for accuracy, then click “Save & Download” to get a completed PDF you can print or email.
5
Submit to HR
Send the saved PDF to your employer’s HR or Benefits department following your organization’s leave‑submission guidelines.

Department of Labor (DOL) formularer

WH-380-E er en af de officielle formularer, der bruges af det amerikanske arbejdsministerium og dets forskellige agenturer til at indsamle oplysninger, administrere programmer og håndhæve arbejdsrelaterede love og regler. Department of Labor er en føderal udøvende afdeling, der er ansvarlig for at fremme og beskytte arbejdstagernes velfærd, sikre fair ansættelsespraksis og føre tilsyn med forskellige aspekter af arbejde og beskæftigelse i USA.

Her er nogle eksempler på formularer fra Department of Labor:

Bekræftelse af beskæftigelsesberettigelse (formular I-9): Mens den administreres af U.S. Citizenship and Immigration Services (USCIS), er formular I-9 ofte forbundet med Department of Labor. Det bruges af arbejdsgivere til at verificere identiteten og ansættelsesberettigelsen for personer, der er ansat til ansættelse i USA.

Family and Medical Leave Act (FMLA) Formularer: DOL's Wage and Hour Division administrerer FMLA, og forskellige former bruges til at implementere og overholde bestemmelserne i denne føderale lov, herunder certificeringen af sundhedspleje Udbyderformular og formularen FMLA-meddelelse om berettigelse og rettigheder og ansvar.

Occupational Safety and Health Administration (OSHA) Formularer: OSHA, en afdeling af DOL, kræver, at visse arbejdsgivere fører registre over skader og sygdomme på arbejdspladsen ved hjælp af formularer som OSHA Form 300, OSHA Form 300A og OSHA Formular 301.

Arbejdsløshedsforsikringsformularer: DOL's Employment and Training Administration fører tilsyn med arbejdsløshedsforsikringsprogrammet (UI), og forskellige former bruges af statslige arbejdsstyrkeagenturer til at administrere og behandle UI-ydelseskrav.

Formularer til overholdelse af løn og timer: DOL's løn- og timeafdeling håndhæver forskellige arbejdslove, herunder Fair Labor Standards Act (FLSA) og Family and Medical Leave Act (FMLA). Arbejdsgivere kan blive forpligtet til at bruge specifikke formularer for at opretholde overholdelse af disse love, såsom optegnelser over arbejdstimer, lønsatser og andre relaterede oplysninger.

Disse eksempler repræsenterer nogle almindelige kategorier af Department of Labor-formularer, men der er mange andre formularer, der bruges af DOL og dets forskellige agenturer til at udføre deres ansvar i forbindelse med arbejde og beskæftigelse. De specifikke formularer, der kræves, kan variere afhængigt af programmet, reguleringen eller håndhævelseshandlingen. Det er tilrådeligt at besøge det officielle websted for det amerikanske arbejdsministerium (www.dol.gov) eller rådføre sig med de relevante DOL-agenturer eller juridiske fagfolk for at få nøjagtige og opdaterede datooplysninger vedrørende de specifikke DOL-formularer, der er relevante for dine arbejdsrelaterede behov eller overholdelseskrav.

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