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.