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Form WH-380-F: How to Request a Leave According to the Leave Act

Form WH-380-F, Certification of Health Care Provider for Employee’s Serious Health Condition

Luckily, due to the wise healthcare policy, there are certain regulations allowing employees to take enough time off work to take care of their sick family members. The US Department of Labor has elaborated such a regulation – the Family Medical Leave Act – stating that an employee can ask their employer for an unpaid leave because of the serious health condition of their family member. To do so, an employee must present enough evidence for such a need. There is a specially created form, an employee should furnish their employer with to be given a necessary leave. This form is a Certification of Health Care Provider for Employee’s Serious Health Condition, shortly labelled a WH-380-F Form. This blog post will cover all the important information you need to learn about using this form.

Who fills out a WH-380-F Form?
The Certification of Health Care Provider for Family Member’s Serious Health Condition Form consists of three parts that are supposed to be completed by three different respondents.
Part 1 (or Section 1 as mentioned in form) is the shortest and it should be completed by the employer.
Section 2 is designed to enable the employee provide all the sufficient information as for their relation to an immediate family member who needs to be tended. Such a family member can be an employee’s parent, spouse or child.
Section 3 is the most extensional part of the form. The health care provider should fill out this block. There, they will provide the medical facts of the sick family member’s condition supported by all the relevant details and also explain the amount of care required.

What is the Certification of Health Care Provider for Family Member’s Serious Health Condition Form for?
This form is an obligatory requirement for asking your employer for the Family and Medical Leave Act (FMLA) protection, as it enables an employee to receive up to 12 weeks of unpaid leave for them to care for their parent, spouse or child who suffers from a serious medical condition. The FMLA program protects the employee from losing their job or demotion due to longtime absence.

Is the Certification of Health Care Provider for Family Member’s Serious Health Condition Form accompanied by any other forms?
There is no need for the submission of any other forms or statements along with the completed WH-380F form. However, some medical records can be used as a reference by the health care provider to properly fill out the document.

When is WH-380-F Form due?
The submission of the completed form does not require meeting a certain deadline. However, so as the health care provider is expected to provide the most valuable part of the information, an appointment of the employee and the health care provider should take place within fifteen days, after the employer has completed their Section 1 of the form.
The employee shall be allowed to take a leave only after the complete certification form is approved by the employer.
The employer should also make sure to keep a copy of the filed WH-380F Form for their company records for at least 3 years.

What do I do with the completed WH-380-F Form?
The form completed by the three respondents (first, the employer, second, the employee, and finally, the health care provider) should be returned to the employer to be kept on the employee’s file.

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