Fill out Form WH-380-F, Certification of Health Care Provider with Instafill.ai

Either the employer or the employee can complete Section I of Form WH-380-F.

A complete and sufficient medical certification must include the name of the family member for whom care will be provided, the relationship of the family member to the employee, a brief description of the care that will be provided, and an estimate of the amount of leave needed.

The medical certification must be returned within 15 calendar days from the date requested, unless it is not feasible despite the employee's diligent, good faith efforts.

The FMLA covers care for a serious health condition, which includes assistance with basic medical, hygienic, nutritional, or safety needs, transportation, physical care, psychological comfort, and other types of care as needed.

A serious health condition, as defined by the Family and Medical Leave Act (FMLA), includes any illness, injury, impairment, or physical or mental condition that involves either inpatient care or continuing treatment by a health care provider. Inpatient care means an overnight stay in a hospital or other medical care facility. Continuing treatment means any treatment by a health care provider or any regimen of continuing treatment, including periodic visits for a chronic condition, for a condition that requires multiple treatments, or for a condition that may cause a period of incapacity of more than three consecutive calendar days.

Part A of Form WH-380-F requires the health care provider to provide the following information about the patient's medical condition: 1. The name, address, and phone number of the health care provider. 2. The patient's name and date of birth. 3. A description of the patient's medical condition, including the approximate date the condition started or will start. 4. The estimated duration of the condition. 5. A description of the type of care needed by the patient, including any procedures, surgeries, or treatments that will be required. 6. If the patient has a chronic condition, the health care provider should indicate that the condition is chronic and requires treatment visits at least twice per year. 7. If the patient requires multiple treatments, the health care provider should indicate that it is medically necessary for the patient to receive multiple treatments.

If the patient has a chronic condition, the health care provider should indicate that the condition is chronic and requires treatment visits at least twice per year. A chronic condition is a condition that requires ongoing medical treatment for an extended period of time. Examples of chronic conditions include asthma, diabetes, and heart disease.

If the patient requires multiple treatments, the health care provider should indicate that it is medically necessary for the patient to receive multiple treatments. The number and frequency of treatments will depend on the specific medical condition and the recommended treatment plan.

If the patient is incapacitated for a continuous period of time, the health care provider should provide the beginning and end dates of the period of incapacity. Incapacitation refers to the inability to perform the functions of one's regular job due to a serious health condition. The health care provider should also indicate the type and extent of the treatment the patient will receive during this period.

If the patient requires intermittent leave, the health care provider should estimate the number of episodes of incapacity, the duration of each episode, and the total duration of incapacity that is expected during the leave period. This information should be provided in the medical certification.

The health care provider plays a crucial role in the FMLA leave process by providing a medical certification that supports the employee's request for leave to care for a family member with a serious health condition. The certification should include the name and contact information of the health care provider, the patient's diagnosis, the expected duration of the serious health condition, and the treatments and procedures the patient will undergo.

If the medical certification is not complete or sufficient, the employer may deny the employee's FMLA leave request. The employer should provide the employee with a written notice explaining the reason for the denial and provide the employee with an opportunity to cure any deficiencies in the certification.

If the employee fails to provide a complete and sufficient medical certification, the employer may deny the employee's FMLA leave request. The employer should provide the employee with a written notice explaining the reason for the denial and provide the employee with an opportunity to cure any deficiencies in the certification.

Employers are not required to request a medical certification for FMLA leave to bond with a healthy newborn child or a child placed for adoption or foster care. However, the employee must provide notice of the need for leave as soon as practicable and must provide proof of the birth or placement of the child.

The Certification for Family Member's Health form (WH-380-F) is used to certify that a family member of an employee is in need of leave due to a serious health condition. This form is required under the Family and Medical Leave Act (FMLA) to establish the eligibility of an employee for FMLA leave.

The Certification for Family Member's Health form (WH-380-F) should be completed by a qualified healthcare provider who has personally treated, examined, or provided care for the family member's health condition.

The Certification for Family Member's Health form (WH-380-F) requires the healthcare provider to provide the following information: the name and contact information of the healthcare provider, the name and relationship of the family member, the date of the first day of the health condition, the expected duration of the health condition, and a description of the health condition and the treatment required.

The completed Form WH-380-F should be returned to the patient, not to the Department of Labor. The patient should then provide the form to their employer to support their request for FMLA leave.

The Certification for Family Member's Health form (WH-380-F) should be submitted to the employer as soon as possible, but no later than 15 calendar days after the first day of the leave. If the healthcare provider is unable to provide the certification within 15 days, the employee should submit a written explanation to their employer explaining the delay and providing an estimated date for submission.