Form WH 380 F Printable

2021 Form WH 380 F— Certification for Health Care Provider for Family Member’s Serious Health Condition under Family and Medical Leave Act is an FMLA form used for requesting leave to take care of a family member.

If a member of your family member needs care due to a serious health condition whether it be an injury or an illness, you can request FMLA leave. However, just like any other reason for an FMLA leave, you must be eligible. The eligibility requirements for employees to go on FMLA leave is as follows.

You must be working for the same employer for at least 12 months prior to the FMLA leave.

You must have worked for at least 1,250 hours prior to the FMLA leave. This equals about 24 hours per week– meaning most part-time employees should be eligible.

You must not exceed the FMLA leave days you’re given. The maximum amount of time an employee can go on leave with FMLA is 12 weeks.

Other than these, your employer needs to have at least 50 employees within a 75-mile radius of the workplace. As long as all the conditions are met, there isn’t anything in your way to go on leave for up to 12 weeks under FMLA.

WH 380 F Instructions

As for filling out Form WH 380 F, it is made up of three sections. While the employer and the employee sections are fairly easy to fill out and understand, the health care provider– not so much. This part of Form WH 380 F must be filled out by the health care provider the employee’s family member visits.

The health care provider will include the estimated amount of time the employee will need to take care of the family member but the FMLA leave isn’t limited to it. The employee can take as much time as he or she needs to provide care for the family member. It is just to give an estimate to the employer with Form WH 380 F to let the employer know how many days may be required.

You can see all these parts of Form WH 380 F from the link down below by viewing the form. This version of Form WH 380 F is also online fillable. Fill out 2021 Form WH 380 F online and e-mail it to your employer or the health care provider if necessary.

One thing you should know is, you cannot enter an elecronic signature on Form WH 380 F on your browser. You will need a PDF filler for that. In addition, you also have the option to use a scanner which is what most professionals prefer — most likely — so as your employer and the health care provider.

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