FMLA Paperwork

I’m often asked to fill out FMLA paperwork, formally known as Certification of Health Care Provider for Employee’s Serious Health Condition (Family and Medical Leave Act). This is either because my patient is ill and they or a family member need to take time off work, or because my patient needs to take time off to care for a family member. Employers want the form as proof that the time taken off is legitimate, even though it is not paid time off.

The four page form is onerous to fill out. If you read the fine print you can see that the Department of Labor estimated it would take 20 minutes to fill out. That’s more time than I get to see a complex medical patient, and at most we charge $25, and often don’t get paid at all. It may be a service to patients, but most of the information requested is not needed, and is not the employer’s business. This task usually falls to primary care physicians. If it’s something we need to do, it should be as simple as possible and not waste our time filling out irrelevant information.

Below is a letter I sent as a suggestion to simplify the form to a single page (formatting of the form altered a little for web display). It has been over two years without a response.

Wage and Hour Division
U.S. Department of Labor, Room S-3502
200 Constitution Ave. NW
Washington, DC 20210

Re: Certification of Health Care Provider for Family Member’s Serious Health Condition, Form WH-380-F

To Whom It May Concern:

As part of the Family and Medical Leave Act (FMLA), employers may require employees submit medical certification of a serious health condition of a covered family member. According to the Paperwork Reduction Act the Department of Labor estimated it takes an average of 20 minutes to fill out the form WH-380-F. I’m not sure what percentage of those 20 minutes is calculated to fall on physicians, but it’s too much. In my busy practice a regular appointment is only 15 minutes. I either get handed this form to fill out in addition to whatever else is dealt with in the appointment, or it gets sent to me to fill out, for which I’m completely un-reimbursed.

I think many questions are unnecessary. Why does it matter when the condition commenced? This is not insurance looking for a pre-existing condition. The duration of the condition is asked in questions 1, 4, 5, 6 and 7.

I’ve been following some of my patients for over 15 years for chronic medical conditions. Why should I have to list every visit they’ve had with me in question 1?

Why do the employers even need to know the diagnoses? Do they have the expertise to know how that will affect the absence of their employee? What business is of theirs in any case?

Below is my suggested form.


Daniel Ginsberg, MD, FACP

NPI Number (must include data below in database at


Physician/Provider Name:_____________________________________
Physician/Provider Address: ___________________________________
Physician/Provider Work Phone:________________________________
Physician/Provider Fax:_______________________________________

Does your patient have a serious health condition that may require our employee to take time off to help in their care?              〈  〉 Yes    〈  〉 No

If so, how much time do you anticipate needed:_________________

〈  〉 A block of time for a limited event, such as surgery or acute illness.

If so, expected duration: _______________
End date if applicable: _________________

Periodic Office Visits/Ancillary Care/Home Care

〈  〉 1-4 times/year within the next year   〈  〉 1-4 times/year indefinitely
〈  〉 5-10 times/year within the next year 〈  〉 5-10 times/year indefinitely
〈  〉 >10 times/year within the next year  〈  〉 > 10 times/year indefinitely

Estimated Time Required for Office Visits/Ancillary Care/Home Care

〈  〉 < 2 hours
〈  〉 2-4 hours
〈  〉 >4 hours

Additional Comments: ___________________________________________



Signature of Healthcare Physician/Provider                                         Date

Author: Daniel Ginsberg, MD, FACP

I'm an internal medicine physician and have avidly applied computers to medicine since 1986, when I wrote my first medically oriented computer programs. So yes, that means I'm at least 35-years-old!

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