Fill Out DOL Form WH-380-F Online
Certification of Health Care Provider for Family Member's Serious Health Condition (FMLA)
U.S. Department of Labor
Certifies a family member's serious health condition to support an employee's FMLA leave to provide care.
Reviewed July 2026
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Form WH-380-F is the Department of Labor's model certification form for FMLA leave taken to care for a spouse, child, or parent with a serious health condition. The family member's health care provider completes the medical portion so the employer can confirm the leave qualifies.
You can complete the WH-380-F in the Universal PDF editor. Enter the employer, employee, and patient information cleanly, add the provider's responses, and download the finished PDF for the employer's FMLA records.
What is Form WH-380-F used for
The FMLA lets eligible employees take job-protected leave to care for a spouse, son, daughter, or parent with a serious health condition. When an employee requests that kind of leave, the employer may require a certification from the family member's health care provider, and the WH-380-F is the DOL's optional model form for it.
Beyond the medical facts, the form asks about the care the employee will provide, such as transportation to appointments or psychological comfort, and the estimated schedule of the leave. Like all FMLA certifications, it is kept by the employer and never filed with the Department of Labor.
Who completes Form WH-380-F
The form moves through the same three hands as the employee version:
- The employer completes Section I with company and employee details.
- The employee completes Section II, describing their relationship to the family member and the care they will provide.
- The family member's health care provider completes Section III with the medical facts and the expected duration of the condition.
How to fill out Form WH-380-F
The employee section matters more here than on the WH-380-E. Be specific about the relationship (spouse, parent, or child) and about what care is needed, since the FMLA covers both hands-on care and arranging for care. For a child age 18 or older, the certification also addresses whether the child is incapable of self-care because of a disability.
The provider indicates whether the patient needs assistance for basic medical, hygiene, nutritional, or safety needs, and estimates how often the employee will need intermittent time off if the leave is not continuous.
Deadlines and retention rules
The timing mirrors the other FMLA certifications: the employer generally requests certification within five business days of learning about the leave, and the employee gets at least 15 calendar days to return it. Incomplete forms must be flagged in writing with a chance to fix them.
Employers keep completed certifications in confidential medical files, separate from personnel records, and retain FMLA documentation for at least three years.
Frequently asked questions
A spouse, son, daughter, or parent with a serious health condition. Parents-in-law are not covered, and adult children generally qualify only if they are incapable of self-care because of a disability.
The health care provider treating the family member, not the employee's own doctor. The employee completes a separate section about the care they will provide.
At least 15 calendar days from the employer's request, unless it is not practicable despite the employee's diligent, good-faith efforts.
No. The employer keeps the completed certification in its confidential FMLA records. The Department of Labor does not collect it.
Employers may use the WH-380-F or their own form, but they cannot require more information than the FMLA regulations allow.
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