Leave Certificate Format
Description
How to fill out FMLA Certification Of Physician?
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FAQ
Among the forms changed were the WH-381, the notice of eligibility and rights and responsibilities; WH-382, designation notice; WH-380-E, medical certification of an employee's serious health condition; and WH-380-F, medical certification of a family member's serious health condition.
Include your name and address, and the name of the patient. Consider including whether the patient should be absent from the activity, or is able to attend in a reduced capacity. Generally, a medical certificate should not reveal a diagnosis, unless the patient consents to this.
FMLA applies to employers with ? 50 employees within a 75 mile radius; employees must have worked 1,250 hours in the past year. FMLA covers unpaid leave-12 weeks of care of self or family member with a serious health condition. This includes spouse, child, or parent.
Complete Section II of the appropriate Certification of Health Care Provider form and give to your treating physician, surgeon, or health specialist to fill out the rest. Health Care Provider can fax completed form to (253) 798-8558.
You must have worked 820 hours in your qualifying period. Nearly every worker can qualify for Paid Leave if they worked a minimum of 820 hours (about 16 hours a week) in Washington during their qualifying period.