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Leave of Absence Medical Certification Form

Monday, March 16, 2026 - 12:00pm

FMLA Medical Certification Forms:

Employee’s serious health condition, form WH-380-E - Use when a leave request is due to the medical condition of the employee.
- Condición de salud grave del empleado, formulario WH-380-E (Español)
Family member’s serious health condition, form WH-380-F - Use when a leave request is due to the medical condition of the employee’s family member.
- Condición de salud grave de un miembro de la familia, formulario WH-380-F (Español)
Military Caregiver Leave of a Current Servicemember, form WH-385 – use when requesting leave to care for a family member who is a current service member with a serious injury or illness.
- Licencia para cuidador militar de un miembro actual de las Fuerzas Armadas, formulario WH-385 (Español)
Military Caregiver Leave of a Veteran, form WH-385-V – use when requesting leave to care for a family member is who a covered veteran with a serious injury or illness.
- Licencia de Cuidador Militar de un Veterano, formulario WH-385-V (Español)

WH-380-E.pdf (176.78 KB)

WH-380-E-es.pdf (212.61 KB)

WH-380-F.pdf (293.17 KB)

WH-380-F-es.pdf (214.38 KB)

WH-385.pdf (368.56 KB)

WH-385-es.pdf (366.23 KB)

wh-385-V.pdf (431.05 KB)

wh-385-V-es.pdf (380.04 KB)