FMLA WH-380-E — Federal Family and Medical Leave Act

The FMLA WH-380-E (Employee Certification of Health-Care Provider for Employee's Serious Health Condition) is the federal Department of Labor form that the employee's treating health-care provider must complete to support an FMLA leave request. The form establishes that the employee has a 'serious health condition' under FMLA (29 U.S.C. §2612) — chronic, ongoing, requiring ongoing treatment, or causing incapacity for more than three consecutive calendar days plus subsequent treatment.

The federal FMLA WH-380-E is a federal record. Misrepresenting a serious health condition to obtain leave entitlement exposes both employee and the certifying clinician to 18 U.S.C. § 1001 (up to five years' imprisonment per false statement) and to civil liability under 29 U.S.C. § 2615. The Department of Labor has prosecuted clinicians who certified FMLA leave based on inadequate documentation.

Failure to identify the specific serious health condition supporting leave. Insufficient clinical detail in §B (medical facts) — needs diagnosis + clinical evidence + treatment course. Omitting frequency / duration estimate in §C (incapacity). Listing only the employee's request without the provider's independent clinical judgement. Misrepresentation: 18 U.S.C. §1001 criminal exposure for knowingly false certification

We draft a narrative attachment to the WH-380-E that fills in §A through §D from the patient's chart, with a clear diagnostic statement, the specific clinical evidence (symptoms, severity indicators, functional limitations), the treatment plan, and an estimate of duration. The clinician reviews and signs. The narrative attaches to the official WH-380-E PDF when submitted to the employer.