Get Dol Wh-380-e 2020-2026

Filling out the DoL WH-380-E form is a crucial step for employees seeking FMLA leave due to a serious health condition. This guide will provide you with clear instructions on completing each section of the form online, ensuring that you can submit a comprehensive medical certification.

Follow the steps to successfully complete the DoL WH-380-E form.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. In Section I, fill in the employee’s name, employer's name, and the date the certification is requested. Ensure that the employee's job title is included; attach a job description if required.
3. Specify the deadline for returning the medical certification, ensuring it is at least 15 calendar days from the date requested.
4. In Section II, Health Care Provider, the provider should complete their contact information, including name, address, and specialty. Ensure the provider signs the form after completion.
5. In Part A, provide detailed medical information about the employee's condition, including the onset date of the condition and estimated duration. Indicate if the patient requires inpatient care or ongoing treatment.
6. In Part B, specify the amount of leave needed, detailing any scheduled medical treatments or appointments. It’s important to provide estimated beginning and end dates for treatment.
7. Describe any essential job functions the employee is unable to perform due to the medical condition in Part C, and date the form appropriately.
8. Review all entries for accuracy and completeness, then save your changes. Users can download, print, or share the completed form as necessary.

Start filling out your DoL WH-380-E form online today!