Texas FMLA Certification of Physician

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Multi-State
Control #:
US-AHI-202
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Word; 
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Description

This AHI form is used by employers who have an employee that has requested medical leave. This form is filled out by the physician of the person that is being treated.
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How to fill out FMLA Certification Of Physician?

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FAQ

Fill out Section 2 of the form. If you are completing form WH-380-F, you will be required to provide information about the family member you are caring for during FMLA leave; such as their full name, your relationship to one another, and a description of your methods for providing care for that person.

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.

Either the employee or the employer may complete Section I. While use of this form is optional, this form asks the health care provider for the information necessary for a complete and sufficient medical certification, which is set out at 29 C.F.R. § 825.306.

WH-380-E (Certification of Health Care Provider for Employee's Serious Health Condition)

Employee's serious health condition, form WH-380-E use when a leave request is due to the medical condition of the employee. Family member's serious health condition, form WH-380-F use when a leave request is due to the medical condition of the employee's family member.

To apply for FMLA, the employee must take an FMLA Medical Certification Form to their health care provider. This form ensures that the employee's or family member's applicable health condition is valid. After receiving the form, the employee must return it within 15 calendar days.

An employer may not deny your request for FMLA leave if you have a protected reason to take it.

To be eligible, an employee has to have worked at least 1250 hours within the last 12 months; has to have worked at least 12 months' total time for the employer; and be employed at a facility at which at least 50 employees are employed within a 75-mile radius - due to the 1250-hour requirement, many part-time employees

The Family Medical Leave Act (also known as FMLA) is a federal law passed in 1993 which provides limited protections for employees that need time off work for medical leave for themselves or a family member. It allows employees to take up to 12 weeks of time off work without risk of termination. FMLA leave is unpaid.

Doctors aren't the only health care providers who may certify FMLA leave. Podiatrists, dentists, clinical psychologists, optometrists and chiropractors can all certify leave, as can nurse practitioners, nurse-midwives, clinical social workers and physician assistants.

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Texas FMLA Certification of Physician