Independent form guide. BrieflyGo is not affiliated with or endorsed by IRS, USCIS, SSA, DOL, or any U.S. government agency. Official forms are sourced from public government websites.
Official form guide
Form WH-380-F: Certification of Health Care Provider for Family Member's Serious Health Condition (FMLA)
Certifies that an employee's family member (spouse, child, or parent) has a serious health condition requiring the employee to take FMLA leave to provide care.
Need help with Form WH-380-F?
Open it in the AI Editor for field guidance, checks, and PDF export.
Need help? AI Editor guides you through every field of Form WH-380-F.
Start filling →Form Overview
DOL Form WH-380-F - Certification of Health Care Provider for Family Member's Serious Health Condition (FMLA)
Certifies that an employee's family member (spouse, child, or parent) has a serious health condition requiring the employee to take FMLA leave to provide care.
Risk Radar
Scan points- 1Forgetting to indicate your relationship to the family member — the form must specify the qualifying relationship.
- 2Healthcare provider leaving blank the statement about need for care — this is required to show the employee's caregiving role.
- 3Submitting a form for a non-qualifying relationship — only spouse, child, or parent qualifies under standard FMLA.
Plain English
Use this form when you need FMLA leave to care for a seriously ill family member. Your family member's doctor fills out the medical sections.
Submission Date
- Filing date: Submit within 15 calendar days of your employer's request for certification.
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
AI co-pilot
Fill it faster. Catch mistakes before you file.
Field map
Compact field-by-field guide
Employee Info
2 items
Employee's full legal name.
Employer's name.
Family Member
2 items
Name of the family member needing care.
Your relationship to the family member (spouse, child, parent).
Medical Provider
2 items
Family member's healthcare provider name.
Type of healthcare provider.
Condition
2 items
When the serious health condition began.
Expected duration of the condition.
Care Needed
1 items
Statement from provider that employee's presence to provide care is needed.
Signature
1 items
Healthcare provider's signature.
Almost done reviewing the fields?
Fillable formOpen in Editor->Quick Facts
Downloads
Source transparency
Copyright & Licensing - US Government Forms
BrieflyGo links to and explains official public form sources. We are not a government agency, and this page is for general form guidance, not legal advice.
Never sign without understanding every clause.
BrieflyGo reviews your contracts in plain English — instantly.