Transcription of Certification of Health Care Provider for Employee’s ...
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Certification of Health Care Provider for Employee’s ...
Page 1 Form WH-380-E Revised May 2015 Certification of Health Care Provider for Department of Labor employee s Serious Health Condition Wage and Hour Division( family and medical leave Act)DO NOT SEND COMPLETED FORM TO THE DEPARTMENT OF LABOR; RETURN TO THE PATIENT OMB Control Number: 1235-0003 Expires: 8/31/2021 SECTION I: For Completion by the EMPLOYER INSTRUCTIONS to the EMPLOYER: The family and medical leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious Health condition to submit a medical Certification issued by the employee s Health care Provider .
Certification of Health Care Provider for . U.S. Department of Labor . Employee’s Serious Health Condition (Family and Medical Leave Act) Wage and Hour Division
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