FMLA for Doctors and Health Professionals (Medical Certifications)

Updated on January 30, 2018
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CC BY 2.0 | Source


I am not a lawyer, nor do I practice law. I am familiar with FMLA primarily from an employee's perspective through my previous positions, personal experience, and self study.

I have worked as a Family and Medical Leave Act (FMLA) Specialist and provided FMLA services to multiple businesses and organizations. This article will show general examples of how to complete standard FMLA paperwork. There are two forms given by the U.S. Department of Labor:

  • If you are taking leave for your own serious health condition, you will find the form (WH-380-E) here.
  • If you are taking leave for a family member's serious health condition, you will find the form (WH-380-F) here.

Before going into detail over the forms, it's useful to note some preliminary points.

FMLA and the Health Insurance Portability and Accountability Act (HIPAA) Laws

The FMLA certification is written to be sufficiently vague, so that HIPAA laws are not violated. You can answer the questions providing only an estimation of treatment and/or absences. This information cannot be reliably linked to specific diagnoses unless specifically stated.

The goal then is to be as vague about the condition as possible while providing as much detail on the absences from work as you are capable of.

For the love of science and medicine, do not, please, do NOT tell me that you aren't a mind-reader/fortune-teller/genie. In your expert medical opinion, drawing on however many years of experience, guess. Typically, the paperwork can be adjusted and resent later.

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CC BY 2.0 | Source

When to guess

Of course you should be as precise as possible, but employees often have deadlines for paperwork once their case is reported, along with deadlines to report their medical issues requiring absence. This means that a surgery date for example can be scheduled far in advance. The employee needs to alert their employer ASAP. They then have 15 days to get supporting paperwork to the company, a deadline provided by the employer. You would need to certify the date of surgery and the recovery period.

The recovery period is dependent on how well the surgery goes, and every patient is different. However, it's common that a hysterectomy requires 6-8 weeks of recovery time. Guess for 8 weeks! If you feel uncomfortable, certify for 1-2 weeks post surgery, then adjust the paperwork for additional time as needed upon the follow up appointment.

Pregnancy: you can put the estimated date of delivery and adjust the paperwork once the baby is born.

Migraines: of course you can't know when a patient will have a migraine, but you do have access to the patient's medical history. The patient may report a migraine twice a month on average. You can put 2 "episodes" (migraines) per month.

Asthma: same as above, ad nauseum.

Keep in mind that if the employee exceeds their frequency, the employer may ask that they re-certify. This means that you will need to either confirm their previous frequency or increase it. You may want to give an overestimation as much as you feel is comfortable and correct.

Three Types of FMLA Leave

  • Continuous Leave of Absence: one block of time, generally considered to be 3+ days. You can have multiple, consecutive continuous leaves.
  • Intermittent Leave of Absence: Any regular interval of absences that don't follow a schedule. This can mean an hour appointment once a month or even several days a year.
  • Reduced Leave of Absence: When leave is scheduled, similar to intermittent leave. This can be when employees can only work 4 hours a day maximum, miss every Monday/Wednesday, or similar.

Continuous FMLA Leave

Section 1 and section 2 are not to be completed by the healthcare providers.

Continuous FMLA leave paperwork, page 1
Continuous FMLA leave paperwork, page 1 | Source

You can put the date you began treating the patient, but it is best to put what is in their medical history.

Part A covers basic medical information, when you treated the patient, when the condition began, etc.

Continuous FMLA leave paperwork, page 2
Continuous FMLA leave paperwork, page 2 | Source

Part A: Medical Facts

Regarding Part A, section 4, this is often left blank because healthcare providers feel uncomfortable releasing this kind of information. However, this can be an area to identify specific needs for the patient. Some employers look so carefully at the amount of leave taken that employees have been penalized for "excessive bathroom breaks". During pregnancy, this is often a concern. You can put information like this here.

Continuous FMLA leave paperwork, page 3
Continuous FMLA leave paperwork, page 3 | Source

Part B: Amount of Leave Needed

Part B is the most important part, particularly section 5; it certifies the block of leave needed for the surgery. The only special part about this is that the doctor has certified for appointments, both pre-op and post-op. This is an intermittent leave, which will be covered in more detail below. For continuous leave, all that really matters is section 5.

Continuous FMLA leave paperwork, page 4
Continuous FMLA leave paperwork, page 4 | Source

Intermittent FMLA Leave

The form is the same as this is for an employee's own health condition. The first page is general information not required to be completed by the healthcare provider.

Intermittent FMLA leave paperwork, page 1
Intermittent FMLA leave paperwork, page 1 | Source
Intermittent FMLA leave paperwork, page 2
Intermittent FMLA leave paperwork, page 2 | Source

Part A: Medical Facts

  • Note the approximate start of the condition, this can sometimes be the date you started to treat the patient, and you may make this explicit in the details.
  • "Probable duration of the condition:" The condition is asthma, and in this case, the condition is lifelong. Some companies don't mind if you put lifelong, others do. The law gives a guideline of one year for all paperwork. To avoid trouble and re-certification, you can put '1 year,' or better yet, a specific date. If you wish to be clear, you can indicate that the condition is lifelong.
  • Use the additional space for more information if you feel it is needed. There's no need to state the condition. You can also discuss this with the patient.

Intermittent FMLA leave paperwork, page 3
Intermittent FMLA leave paperwork, page 3 | Source

Adjusting Leave*

Most companies will accept previously completed FMLA paperwork with minor changes. For example, you could scratch out the frequency listed under section 7 and write a 5 instead of 3. You could then initial your name next to the change and resend the documents. In some cases however you will need to complete new paperwork.

Part B: Amount of Leave Needed

Section 5 is for continuous leave, and isn't needed for intermittent leave. Section 6 hasn't been completed, because the leave from work will be random due to asthma attacks. Also, treatments and appointments can be scheduled around work, so no appointments are certified for. This section could be completed if appointments are necessary, in the same was as section 7.

Section 7 is for flare-ups, such as asthma attacks, migraines, low blood sugar, etc. Here it is listed as 3 times per month, lasting one day. This can easily be changed to 3 times per week, or 3 times per 2 months. If you'd like to note anything special about the leave taken, such as different time intervals, please do so in the notes.

The spring months may cause more flare-ups due to the pollen in the air, and the patient may have to take leave more than expected. When this happens, you can adjust the leave as needed at that time when you have a better estimation.*

Intermittent FMLA leave paperwork, page 4
Intermittent FMLA leave paperwork, page 4 | Source

Reduced FMLA Leave

Reduced schedules are a mix of continuous and intermittent leave. The leave is known ahead of time but is generally less than 3 days. This is helpful when you know the patient shouldn't stand for more than 4 hours a day, then they will need to be reduced to working part-time, 20 hours a week. There can also be intermittent leaves plus reduced leaves. When making a determination, if it can be planned, make it reduced. If it's spontaneous, make it intermittent. *For more on determinations, see below.

Reduced FMLA leave paperwork, page 1
Reduced FMLA leave paperwork, page 1 | Source

FMLA For a Family Member

In this case, the patient has listed the situation, and the doctor is agreeing to what's requested. This may make you uncomfortable as the healthcare provider, because you are certifying for the patient's caregiver and not for the patient, them self. However, this is what is expected under the law. You can simply certify what kind of care is likely needed for a patient with that condition. Even simple tasks such as bathing, feeding, etc. can be given an estimated amount of time. Try to think of it in these terms, and you should be able to medically justify any leave the caregiver truly needs.

Reduced FMLA leave paperwork, page 2
Reduced FMLA leave paperwork, page 2 | Source

Part A: Medical Facts

We certify the start date as 12/13/13 and the end date as 12/12/14, i.e. one full year. We can do this even though we may need to renew for another year, or sadly, even though the patient may pass away after a few more months.

You may choose to leave section 3 blank.

Reduced FMLA leave paperwork, page 3
Reduced FMLA leave paperwork, page 3 | Source

Part B: Amount of Leave Needed

The most important thing to remember about this section is that you are completing it for the caregiver, the employee, not the patient. You will need to use the medical facts surrounding the patient to certify leave taken.

Section 4:

Estimating the dates of incapacity: this will be the length of time the employee will be allowed to take leave.

"During this time, will the patient need care?" If you check no, the employee will be denied leave, because you've said the patient doesn't have a severe enough need.

"Explain the care needed by the patient and why such care is medically necessary."
Here, you may wish to list all daily needs if the patient is so incapacitated, e.g. bathing, transportation, feeding, etc. It can be as simple as "transportation to appointments." You can also list it as medically necessary for the patient's recovery. This section will depend on how critically the company examines the medical certification.

Section 5:

This section concerns treatments and appointments. Whenever the patient is receiving this type of care, it should be listed as closely as possible. For example, the caregiver may need to drive home to administer an insulin shot. This can be listed based on how many times a week the shots need to be given. The caregiver may need to drive home from work to deliver them.

Section 6:

This is regarding episodes of incapacity, a flare up that occurs suddenly. See the example given. You may also like to look at the intermittent leave for the employee's own health condition.

Reduced FMLA leave paperwork, page 4
Reduced FMLA leave paperwork, page 4 | Source

Part B: Amount of Leave Needed

Section 7:

This section is for emergency situations, such as asthma attacks, low blood sugar, etc. For this leave, it isn't necessary. In other situations it may be, so please see above under "Intermittent FMLA Leave" for examples.

Additional Comments:

Anything you feel should be known. There is no need to list the condition here.

Different Types of FMLA Forms

The Department of Labor forms aren't necessary to approve FMLA, legally. Many companies will accept multiple forms or offer their own. The main concern is getting the information communicated. Some companies will accept the information if it's legible on a napkin! You can use the above forms and examples as templates. Every situation is different, but as long as common sense is exercised with an eye towards the needs of all parties involved, everything should be fine.

This article is accurate and true to the best of the author’s knowledge. Content is for informational or entertainment purposes only and does not substitute for personal counsel or professional advice in business, financial, legal, or technical matters.


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    • profile image


      8 weeks ago

      From a providers standpoint...need answer

      Say a patient was seen in the ER on 8/6 and discharged the same day and our physician did NOT treat the pt at that time. Pt did go back to the ER on 8/9 and our physician did start treating the patient at that time. So, on the form in Part B number 5 under the incapacitated dates can we, as the physician's office, say the pt is incapacitated starting on 8/5 when we didn't start treating the pt until 8/9? Please advise.

    • profile image

      To Pee 

      5 months ago


      Employers must allow 15 days for an employee to return the cert. Employees are also required to give 30 days notice to an employer when leave is foreseeable. If you delay in returning a patient's FMLA paperwork, their employer could deny or delay the designation of FML. The paperwork is time consuming, but is more so on the end of the employer. You would be helping your patients out by addressing the requests as soon as possible.

    • profile image


      5 months ago

      I have a question from a healthcare professional standpoint.

      Is there a specified legal time frame in which the FMLA forms must be completed? We have become inundated with requests for FMLA and this can be very time consuming.

    • profile image

      Steven Hill 

      6 months ago

      If you have intermittent fmla and the doctor fills in the estimated time as 2-3 times per month 1-2days per episode is that the only amount of time you are allowed to miss? What if your doctor includes patient need off work when flare up occurs? My employer is telling me i can only use if 6 times a month. I thought i could use up to 12 weeks per 12months.

    • profile image


      6 months ago

      Wondering if you can help, Does my doctors office need a ROI signed from me to fill out FLMA paperwork? I've never had to do this before and now they are requiring it

    • profile image


      11 months ago

      My father fell 30 feet from his roof. He suffered multiple traumatic injuries. He has been back and forth between the hospital and rehab for the past 2 months. He tentatively will be discharged home in a few weeks. He will need almost total care at home. He lives 10 hours away and his wife needs help with caring for him. I applied for fmla. None of his doctors will fill out the fmla form so I can help with his care. However they did send his history and physical for my family doctor to review in order to complete the paperwork. My doctor had no problem completing the fmla form. However, my employer is denying me fmla because none of the treating physicians completed the form. What do I do now?

    • PhilosopherPrince profile imageAUTHOR

      Elliott Ploutz 

      14 months ago from Las Vegas, Nevada

      Hello Ms. Bowens,

      I'm very sorry to hear that. FMLA is designed for when leave is medically necessary, so the doctors might not feel comfortable completing the paperwork.

      I would suggest continuing to discuss with the doctors and administrators. If you have the means, you can also transfer the patient to another facility or new doctor. If the patient has a primary care doctor who is more understanding, you can try having them fill out the paperwork as well.

      I wish you both well.

    • profile image

      Shrelle Bowens 

      14 months ago

      What do you do when the Doctor does not want to fill out the

      caregiver's FMLA paperwork?

    • PhilosopherPrince profile imageAUTHOR

      Elliott Ploutz 

      15 months ago from Las Vegas, Nevada

      Hello Bri,

      I would check with your HR on what form they want for bonding time. You are entitled to this time under law, and you should take it! I would think the form should be WH-380-F, leave for a family member. Make it explicit that this is for bonding time/taking care of the child.

    • profile image


      15 months ago

      Do you have to fill out the WH-380-E for bonding time? I called my dr and they said they do not fill this out because they have already submitted their 6 weeks when I had my baby

    • PhilosopherPrince profile imageAUTHOR

      Elliott Ploutz 

      17 months ago from Las Vegas, Nevada

      Hello Julie,

      I'm very sorry to hear that. FMLA is designed for when leave is medically necessary, so the doctors might not feel comfortable completing the paperwork.

      I would suggest continuing to discuss with the doctors and administrators. If you have the means, you can also transfer her to another facility. If she has a primary care doctor who is more understanding, you can try having them fill out the paperwork as well.

      I wish you both well.

    • profile image

      Julie Dominguez 

      17 months ago

      I NEED HELP!!!!! I made the decision to place my mother on hospice care at the nursing home where my mother is living in February this year. I applied for FMLA from my employer and they sent me the paperwork right away. My problem is with the nursing home. The administrator there ( Becky) says the doctor is refusing to fill out the paperwork because belair is taking care of my mother not me. I explained to her that the I am not taking s leave of absence to care for my mother or am I taking over as caregiver. The FMLA is for the days when my needs the emotional support only family can give and to protect me from losing my job for calling off to offer that support. The Administrator is still refusing to have the paperwork filled out and now the paperwork work has disappeared and no one at the nursing knows what happened to it so I have to start the process all over again. I called hospice to see if they can help and I am still waiting for a answer from them. I just don't know where to go from here. IM SM SO LOST AND FRUSTRATED!!!!!! Can someone give me answer on what to do now.

    • PhilosopherPrince profile imageAUTHOR

      Elliott Ploutz 

      20 months ago from Las Vegas, Nevada

      Hi Jessica,

      I'm sorry to hear about that! We did face that situation sometimes. There are doctors who are very concerned about HIPPA laws or think employees are trying to have an excuse to get out of work. It's very frustrating.

      I would sometimes suggest that I call the doctor's office on the employee's behalf to confirm with them that this is okay. Some doctors are very stubborn and arrogant. Maybe you can have an HR member call the doctor on your behalf to confirm with them, but HR members aren't always so proactive.

      Really it comes down to convincing the doctor.

      Good luck to you.

    • profile image

      Jessica C. 

      20 months ago

      What about a situation where a physician refuses to fill out FMLA forms when they are for the caretaker and not the patient? My grandmother has advanced dementia and requires round-the-clock care. My grandfather and my mother are her primary caretakers. However, my mom needs to use intermittent FMLA leave so that she can be off at least one weekend day and so that she does not work past 8 p.m. on the nights she has to go to her parents house to help with bedtime. My grandmother's physician refused to fill out the FMLA paperwork since my mom is "not the patient." It's a very strange situation. As an attorney who deals with FMLA claims somewhat regularly, this baffles me.

    • profile image


      4 years ago

      More posts of this quliaty. Not the usual c***, please


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