U.S. Department of Labor (DOL) · United States

Fill Form WH-380-F online — free with AI

Certification of Health Care Provider for Family Member's Serious Health Condition under the Family and Medical Leave Act

Upload your blank Form WH-380-F from U.S. Department of Labor (DOL), let AI auto-detect every field, type or dictate your data, and download the completed PDF in seconds. No watermarks, no install.

Tap to upload your PDF

or browse files — free account required, no credit card

By uploading, you confirm you have the legal right to use this document.

Free to start No watermark Works on any device GDPR compliant

JustFill is not affiliated with U.S. Department of Labor (DOL). This is an independent third-party tool to help you complete Form WH-380-F. Always download the current blank form from the official source and verify your completed copy before signing or submitting. Official Form WH-380-F from U.S. Department of Labor (DOL)

Quick answer

Form WH-380-F is the U.S. Department of Labor's FMLA Certification of Health Care Provider for a Family Member's Serious Health Condition. The employee completes Section II about the family member and care needed, and the family member's health care provider completes Section III with the medical certification. JustFill lets you fill it online for free, then download the PDF.

Form
Form WH-380-F
Issued by
U.S. Department of Labor (DOL)
Country
United States
Cost to fill
Free

What is Form WH-380-F?

Form WH-380-F is the FMLA Certification of Health Care Provider for Family Member's Serious Health Condition, an optional U.S. Department of Labor form employers can use when an employee requests FMLA leave to care for a family member with a serious health condition. It gathers the medical certification an employer is allowed to require under the Family and Medical Leave Act. The form has three sections: Section I, where the employer lists the employee, the date the certification was requested, and the return deadline; Section II, where the employee names the family member, their relationship, the care to be provided, and the leave estimate; and Section III, where the family member's health care provider gives the medical certification in Part A (medical information) and Part B (amount of leave needed). The current edition is revised June 2020 (OMB 1235-0003). With JustFill, the AI detects each field on the PDF, so you or the provider can type or dictate answers, handle scanned copies, and finish without Adobe Acrobat.

Download the Form WH-380-F form PDF — free

The official WH-380-F PDF is free to download from the U.S. Department of Labor Wage and Hour Division at dol.gov/agencies/whd/fmla/forms. JustFill opens that same PDF in your browser so the employee and provider can fill it and download a completed copy with no Adobe Acrobat required.

Get the official Form WH-380-F PDF from U.S. Department of Labor (DOL)

Who fills out Form WH-380-F?

  • An employee requesting FMLA leave to care for a spouse, parent, or child with a serious health condition (completes Section II).
  • The family member's treating physician or health care provider, who completes the Section III medical certification.
  • An HR or leave administrator who fills Section I with the employee name, request date, and return-by deadline.
  • A nurse or medical office staffer entering the provider's clinical answers in Parts A and B on the provider's behalf.
  • A manager or small-business owner handling the employer portion of an employee's FMLA leave request.

Field-by-field breakdown

What each section of Form WH-380-F asks for. JustFill’s AI will detect these fields automatically when you upload the PDF — review the breakdown below so you know what to enter.

Section I - Employer

Employee name, employer name and date the certification was requested, and the date the certification must be returned by.

Family member and relationship (Section II)

Name of the family member needing care and whether they are your spouse, parent, or child.

Care and leave estimate (Section II)

The care you will provide (basic needs, transportation, physical care, psychological comfort, other) and your best estimate of leave needed, including any reduced schedule.

Provider contact info (Section III)

Health care provider's name, business address, type of practice or specialty, telephone, fax, and email.

Part A - Medical information

Patient name, when the condition started, how long it will last, the type of care needed, and which condition category applies (inpatient, chronic, pregnancy, etc.).

Part B - Amount of leave needed

Planned treatments, referrals, periods of incapacity, and any intermittent or episodic flare-up estimates tied to the condition.

Employee signature

The employee's signature and date completing Section II before passing the form to the provider.

Health care provider signature

The provider's signature and date certifying the medical information in Section III.

Common mistakes to avoid

  • 1Sending the completed form to the Department of Labor instead of returning it to the employee, as the form clearly instructs.
  • 2The provider leaving Part B blank after checking a condition in Part A, so the certification does not state the amount of leave needed.
  • 3Missing the return deadline in Section I, which under FMLA must allow the employee at least 15 calendar days to submit the certification.

How JustFill helps you complete Form WH-380-F

AI field detection

Upload your blank Form WH-380-F PDF and our AI maps every fillable region — no manual drawing required.

Save as template

Fill Form WH-380-F once, save the layout, then reuse it instantly for the next client, employee, or filing.

Your data stays yours

GDPR compliant. Export or delete all your data anytime from your account settings.

Ready to fill Form WH-380-F?

Drop your blank Form WH-380-F PDF below. Free account, no credit card.

Tap to upload your PDF

or browse files — free account required, no credit card

By uploading, you confirm you have the legal right to use this document.

Related forms

U.S. Department of Labor, Wage and Hour Division

WH-380-E

Form WH-380-E: FMLA Certification of Health Care Provider for Employee's Serious Health Condition

U.S. Department of Labor, Wage and Hour Division

WH-347

Form WH-347: Payroll (Davis-Bacon Certified Payroll)

U.S. Office of Personnel Management

SF-15

Standard Form 15 (SF-15): Application for 10-Point Veteran Preference

Internal Revenue Service (IRS), U.S. Department of the Treasury

Form 1040

Form 1040, U.S. Individual Income Tax Return

Frequently asked questions

Yes. It is a free public-domain form from the U.S. Department of Labor, and filling it online with JustFill is free too.
Download the official PDF from dol.gov/agencies/whd/fmla/forms, or open it in JustFill, which loads the same form so you can complete and save it.
Yes. JustFill's AI detects each field across the employee and provider sections, so you can type or dictate answers online and download the finished PDF, no Adobe needed.
It is the FMLA medical certification an employer can require when an employee needs leave to care for a family member with a serious health condition.
Both. The employee completes Section II about the family member and care needed, and the family member's health care provider completes the Section III medical certification.
Return it to the employee (not to the Department of Labor); they give it to their employer. JustFill helps you fill and download the form before handing it off.

Official source: Form WH-380-F on U.S. Department of Labor (DOL)’s website

JustFill is an independent product and is not affiliated with, endorsed by, or sponsored by U.S. Department of Labor (DOL) or any government agency. Always verify your completed form on the official version before signing or submitting.