| dataset_desc |
Description of the Document
The document provided Description of the Document
The document provided is the "Certification of Health Care Provider for Employee’s Serious Health Condition," officially known as Form WH-380-E (Revised June 2020), issued by the U.S. Department of Labor’s Wage and Hour Division. This form is utilized by employers to verify that an employee requires leave under the Family and Medical Leave Act (FMLA) due to a serious health condition. It serves as a medical certification that employers can request to ensure the leave request is valid. The form is divided into three main sections: the first section is for the employer to provide employee details and essential job functions; the second section is completed by the health care provider and details the medical facts, the nature of the condition, and the amount of leave needed; and the final section defines what constitutes a "serious health condition" under the law. The form emphasizes privacy, instructing that the completed document should be returned to the patient (the employee) and not sent to the Department of Labor, and it includes strict warnings against including genetic information.
Key Points and Headings
1. Form Identification and Instructions
Form Name: Certification of Health Care Provider for Employee’s Serious Health Condition.
Form Number: WH-380-E.
Agency: U.S. Department of Labor, Wage and Hour Division.
Expiration Date: 6/30/2026.
Instructions: Employers must give employees at least 15 calendar days to return the form. The completed form must be returned to the patient/employee, not the Department of Labor.
Confidentiality: Medical certifications must be kept in separate confidential files, not in regular personnel files.
2. Section I: Employer Information
Purpose: Identifies the employee and the context of the request.
Details Required: Employee name, employer name, and the date the certification was requested.
Job Details: Employers should provide the employee's job title, regular work schedule, and a statement of essential job functions. If these aren't provided, the health care provider relies on the employee’s description.
3. Section II: Health Care Provider Information
Provider Details: Name, business address, type of practice/specialty, and contact information.
Note on Privacy: The form warns against disclosing genetic tests, genetic services, or family medical history.
4. Part A: Medical Information
Condition Start Date: When the condition began or will begin.
Duration: Estimate of how long the condition will last.
Categories of Serious Health Condition: The provider must check which category applies:
Inpatient Care: Overnight stay in a hospital or residential facility.
Incapacity Plus Treatment: Incapacity lasting more than 3 consecutive full days plus treatment (e.g., prescription meds or therapy).
Pregnancy: Includes incapacity due to pregnancy or prenatal care.
Chronic Conditions: Conditions requiring visits at least twice a year (e.g., asthma, diabetes).
Permanent/Long-term: Incapacity that is permanent or long-term (e.g., Alzheimer’s).
Multiple Treatments: Conditions requiring treatments (e.g., chemotherapy) that would cause incapacity of 3+ days if untreated.
5. Part B: Amount of Leave Needed
Planned Treatment: Dates of scheduled medical visits (e.g., physical therapy).
Referrals: Dates if referred to other providers.
Reduced Schedule: If the employee can work fewer hours or days (e.g., 4 hours/day instead of 8).
Continuous Incapacity: The specific start and end dates for a period where the employee cannot work at all.
Intermittent Leave: For episodic flare-ups, the provider must estimate the frequency (how often) and duration (how long) of episodes over the next 6 months.
6. Part C: Essential Job Functions
Capacity to Work: The provider must indicate if the employee is unable to perform one or more essential job functions due to the condition.
Identification: The provider must identify at least one specific function the employee cannot perform.
Topics for Presentation
If you are creating a training or presentation on this form, these topics would be relevant:
Understanding FMLA Eligibility: When can an employer request this form?
Employer Responsibilities: What information must the employer provide (job descriptions) and how long must they wait for the form?
Defining "Serious Health Condition": Breaking down the 6 categories (Inpatient, Chronic, Pregnancy, etc.).
The Role of the Health Care Provider: What specific medical details are they legally allowed to share?
Types of Leave: Explaining the difference between Continuous Leave, Reduced Schedule, and Intermittent Leave.
Confidentiality and Compliance: Where to store the form and what not to ask (e.g., genetic information).
Handling Incomplete Forms: Steps to take if a certification is vague or insufficient.
Review Questions
Test your knowledge of the form with these questions:
Who receives the completed Form WH-380-E?
Answer: The patient (the employee), not the Department of Labor.
What is the minimum amount of time an employer must give an employee to return the completed medical certification?
Answer: At least 15 calendar days.
Which section of the form asks the health care provider to identify if the employee can perform their essential job functions?
Answer: Part C.
If an employee has a condition like asthma that requires visits twice a year, which "serious health condition" category applies?
Answer: Chronic Conditions.
According to the form, is "incapacity" defined strictly as the inability to work?
Answer: No. Incapacity is defined as the inability to work, attend school, or perform regular daily activities.
What specific type of information must the health care provider avoid including in the form?
Answer: Genetic tests, genetic services, or the manifestation of disease in family members.... |