Guides · FMLA certification

How to fill out Form WH-380-E — a field-by-field guide for clinicians

By the PatientPapers team (physician-built) · Published July 4, 2026 · Updated August 7, 2026

The WH-380-E lands on a clinician's desk more than any other administrative form. It isn't billing paperwork and it isn't a disability opinion — it is a certification, defined by regulation, that an employer may require before granting job-protected FMLA leave. Understanding what each field is legally asking makes it fast; guessing makes it bounce back from HR with a deficiency notice and your patient's leave at risk.

This guide walks the June 2020 revision item by item, with the regulatory definition behind each field. It describes what the form asks — never what you should certify. That judgment is yours.

Before you start: whose form is this, and what are the deadlines?

• Section I belongs to the employer (or the employee). Employee name, employer name, job title, schedule, and the essential-functions statement are theirs to complete. It's acceptable to leave employer-side items blank if they weren't provided — your certification is Section II onward. Form Section I; 29 C.F.R. § 825.306
• The employee has at least 15 calendar days from the employer's request to return the completed certification. An incomplete or insufficient certification can lead to denial of the leave request, after a 7-day cure opportunity. 29 C.F.R. §§ 825.305, 825.313
• The employer may contact you only to authenticate or clarify the certification — not to seek information beyond it, and never through the employee's direct supervisor. 29 C.F.R. § 825.307(a)
• No genetic information. Do not provide information about genetic tests, genetic services, or conditions manifesting in the employee's family members. 29 C.F.R. § 1635.3; form Part A instructions

Section II — your contact block

Printed name of the certifying provider (the same person who signs page 4), business address, practice type or specialty as it relates to the condition, phone, fax, and email. The specialty line supports the certification's authenticity if the employer verifies it.

Part A — medical facts

Item 1 — approximate date the condition started or will start

An approximate date is what's asked: a best estimate from your medical knowledge and examination, not a documented first-symptom date. "Approximately 2019" for a long-standing chronic condition is a legitimate answer.

Item 2 — your best estimate of how long it lasted or will last

This is the field that most often sinks a certification. The form warns on its face that "lifetime," "unknown," or "indeterminate" may not be sufficient to determine FMLA coverage. A range in weeks or months usually is — and for chronic conditions, "ongoing — chronic condition" paired with a quantified episodic pattern in Part B item 9 gives the employer what the regulation needs.

Item 3 — the six serious-health-condition categories

Check every category that applies; each has a precise regulatory definition:

If none apply, the "None of the above" box exists for exactly that purpose — the form sends you straight to signature, and the certification honestly reports that the condition, as presented, doesn't fit an FMLA category.

Sub-items under the categories ask for the supporting specifics: admission date(s) for inpatient care; the incapacity window and visit dates for incapacity-plus-treatment (those visit dates are the § 825.115(a) test); whether a regimen of continuing treatment resulted (prescription medication or therapy requiring special equipment — beyond self-care); and the expected delivery date for pregnancy.

Item 4 — other medical facts (optional)

You may, but are not required to, add appropriate medical facts about this condition: symptoms, regimen, use of specialized equipment (nebulizer, dialysis). Limit it to the condition for which leave is sought, and remember some state laws restrict diagnosis disclosure.

Part B — amount of leave needed

Item 5 — planned medical treatments

Scheduled visits for this condition (psychotherapy, prenatal appointments, specialist follow-ups). Known dates or a stated schedule ("monthly through October") both work — the employee is entitled to leave for these absences.

Item 6 — referrals to other providers

Treatment courses delivered elsewhere — cardiology, physical therapy, chemotherapy, infusions. State the nature of the treatment, your best-estimate date range, and the duration including recovery (e.g., "every 2 weeks for 12 weeks, about 5 hours each including recovery").

Item 7 — reduced schedule

The form asks for what the employee is able to work — capacity, not restriction ("5 hours/day, up to 25 hours a week"), with a date range. Duty restrictions (no lifting, voice rest) belong in Part C, not here.

Item 8 — continuous incapacity

A single continuous period unable to work, including treatment and recovery time, with best-estimate start and end dates. Note the tense checkboxes ("was / will be") — both can be true when a leave straddles today.

Item 9 — intermittent leave: frequency × duration

For episodic conditions, estimate over the next 6 months how often episodes of incapacity will occur (times per day/week/month) and how long each lasts (hours/days). This estimate sets the envelope of protected intermittent absences. A frequency without an episode length — or vice versa — is the second-most-common reason certifications come back. Realistic specificity matters more here than anywhere else on the form.

Part C — essential job functions

Item 10 asks whether the employee was / is / will not be able to perform one or more essential job functions, and to identify at least one. Use the employer's essential-functions statement from Section I if provided; if not, the regulation permits relying on the employee's own description of the job. Note that an employee absent to receive treatment is considered unable to perform essential functions during that absence — treatment-only leave still supports Part C.

Signature and date

The certifying provider signs and dates page 4. The signature certifies everything above it — which is why every estimate on the form should be one you'd stand behind on review.

Why certifications bounce: the five usual suspects

1. "Unknown / indeterminate" duration in Part A item 2 (the form explicitly warns against it).
2. Intermittent estimates missing half the equation — frequency without episode length, or the reverse.
3. The >3-consecutive-days confusion — episodic single-day absences checked as "incapacity plus treatment" instead of chronic.
4. Restrictions where capacity was asked — item 7 wants what the employee CAN work.
5. Blank Part C — no essential function identified when the condition plainly limits one.

FAQ