WebPage 1 of 4 Form WH-380-F, Revised June 2024 . Employee Name: (3) Briefly describe the care you will provide to your family member: ... FMLA leave. (e.g., use of nebulizer, dialysis) PART B: Amount of Leave Needed For the medical condition(s) checked in Part A , complete all that apply . Several questions seek a response as to the frequency or ... WebForm WH–380–E and WH–380–F, as revised, or another form containing the same basic information, may be used by the employer; however, no information may be required beyond that specified in §§ 825.306, 825.307, and 825.308. In all instances the information on the form must relate only to the serious health condition for which the ...
Certification of Health Care Provider for U.S. Department of …
WebFamily Medical Leave Act (FMLA) Forms Form WH-380E: Certification of Health Care Provider (PDF) Certification of Health Care Provider for Employee’s Serious Health … WebFeb 5, 1999 · Under the Family and Medical Leave Act of 1993 (FMLA), most Federal employees are entitled to a total of up to 12 workweeks of unpaid leave during any 12 … how to swap back to mac bootcamp
SECTION I - EMPLOYER
WebFamily and Medical Leave Act: WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition. For Download, please click on the Certification of … WebFor FMLA to apply, care of the patient must be medically necessary. Briefly describe the type of care needed by the patient (e.g., assistance with basic medical, hygienic, nutritional, safety, transportation needs, physical care, or psychological com fort). Page 2 of 4 Form WH-380-F, Revised June 2024 WebPage CONTINUED1 ON NEXT PAGE Form WH -380 E Revised May 2015 _____ 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 . OMB Control Number: 1235-0003 . Expires: 8/31/2024 SECTION I: For Completion by the … reading slogans for middle school