Print This Page
E-mail This PageDOL Form WH-380-E
| Agency: | WHD |
| Title: | Certification of Health Care Provider for Employee’s Serious Health Condition |
| Form Description: | Certification of Health Care Provider for Employee’s Serious Health Condition |
| OMB Control Number: | 1235-0003 |
 |
DOL Form WH-380-E
| Agency: | WHD |
| Title: | Certification of Health Care Provider for Employee’s Serious Health Condition |
| Form Description: | Certification of Health Care Provider for Employee’s Serious Health Condition |
| OMB Control Number: | 1235-0003 |
|
