Medical Certification - Content

Required Information
When leave is taken because of an employee's own serious health condition, or the serious health condition of a family member, an employer may require an employee to obtain a medical certification from a health care provider that includes the following information:

1. The name, address, telephone number and fax number of the health care provider and type of medical practice or specialization;
2. The approximate date on which the serious health condition commenced and its probable duration;
3. A statement or description of appropriate medical facts regarding the patient's health condition for which FMLA leave is requested. These facts must be sufficient to support the need for leave and may include information on:
   • Symptoms
   • Diagnosis
   • Hospitalization
   • Doctor visits
   • Prescribed medication
   • Referrals for evaluation or treatment (for example, physical therapy)
   • Other regimen of continuing treatment;
4. If the employee is the patient, information sufficient to establish that the employee cannot perform the essential functions of his or her job, as well as the nature of any other work restrictions and the likely duration of such inability;
5. If the patient is a qualifying family member with a serious health condition, information sufficient to establish that the family member is in need of care and an estimate of the frequency and duration of the leave required to care for the family member;
6. If an employee requests leave on an intermittent or reduced schedule basis for planned medical treatment of the employee's or a qualifying family member's serious health condition, information sufficient to establish the medical necessity for such intermittent or reduced scheduled leave and an estimate of the dates and duration of such treatments and any periods of recovery;
7. If an employee requests leave on an intermittent or reduced schedule basis for the employee's serious health condition, including pregnancy, that may result in unforeseeable episodes of incapacity, information sufficient to establish the medical necessity for such intermittent or reduced schedule leave and an estimate of the frequency and duration of the episodes of incapacity; and
8. If an employee requests leave on an intermittent or reduced schedule basis to care for a qualifying family member with a serious health condition, a statement that such leave is medically necessary to care for the family member, which can include assisting in the family member's recovery, and an estimate of the frequency and duration of the required leave.

DOL has developed two optional forms (WH-380E and WH-380F) for employees or their family members to use in obtaining medical certification, including second and third opinions, from health care providers that meets FMLA's certification requirements. The employer may use these forms or other forms containing the same basic information; however, no information may be required beyond that specified in the FMLA regulations. In all instances, the information on the forms must relate only to the serious health condition for which the current need for leave exists. . An employer may not reject a medical certification that otherwise meets these requirements due to the form of the certification provided.

Continue to Medical Certification – Authentication and Clarification or Return to Required Documentation/Certifications from Employees.

For more information on this aspect of the FMLA, see the FMLA regulations: § 825.306