[Code of Federal Regulations]

[Title 29, Volume 3]

[Revised as of July 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 29CFR825.306]



[Page 781-782]

 

                             TITLE 29--LABOR

 

         CHAPTER V--WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR

 

PART 825_THE FAMILY AND MEDICAL LEAVE ACT OF 1993--Table of Contents

 

 Subpart C_How do Employees Learn of Their FMLA Rights and Obligations, 

            and What Can an Employer Require of an Employee?

 

Sec.  825.306  How much information may be required in medical 

certifications of a serious health condition?



    (a) DOL has developed an optional form (Form WH-380, as revised) for 

employees' (or their family members') use in obtaining medical 

certification, including second and third opinions, from health care 

providers that meets FMLA's certification requirements. (See Appendix B 

to these regulations.) This optional form reflects certification 

requirements so as to permit the health care provider to furnish 

appropriate medical information within his or her knowledge.

    (b) Form WH-380, as revised, or another form containing the same 

basic information, may be used by the employer; however, no additional 

information may be required. In all instances the information on the 

form must relate only to the serious health condition for which the 

current need for leave exists. The form identifies the health care 

provider and type of medical practice (including pertinent 

specialization, if any), makes maximum use of checklist entries for ease 

in completing the form, and contains required entries for:

    (1) A certification as to which part of the definition of ``serious 

health condition'' (see Sec.  825.114), if any, applies to the patient's 

condition, and the medical facts which support the certification, 

including a brief statement as to how the medical facts meet the 

criteria of the definition.



[[Page 782]]



    (2)(i) The approximate date the serious health condition commenced, 

and its probable duration, including the probable duration of the 

patient's present incapacity (defined to mean inability to work, attend 

school or perform other regular daily activities due to the serious 

health condition, treatment therefor, or recovery therefrom) if 

different.

    (ii) Whether it will be necessary for the employee to take leave 

intermittently or to work on a reduced leave schedule basis (i.e., part-

time) as a result of the serious health condition (see Sec.  825.117 and 

Sec.  825.203), and if so, the probable duration of such schedule.

    (iii) If the condition is pregnancy or a chronic condition within 

the meaning of Sec.  825.114(a)(2)(iii), whether the patient is 

presently incapacitated and the likely duration and frequency of 

episodes of incapacity.

    (3)(i)(A) If additional treatments will be required for the 

condition, an estimate of the probable number of such treatments.

    (B) If the patient's incapacity will be intermittent, or will 

require a reduced leave schedule, an estimate of the probable number and 

interval between such treatments, actual or estimated dates of treatment 

if known, and period required for recovery if any.

    (ii) If any of the treatments referred to in subparagraph (i) will 

be provided by another provider of health services (e.g., physical 

therapist), the nature of the treatments.

    (iii) If a regimen of continuing treatment by the patient is 

required under the supervision of the health care provider, a general 

description of the regimen (see Sec.  825.114(b)).

    (4) If medical leave is required for the employee's absence from 

work because of the employee's own condition (including absences due to 

pregnancy or a chronic condition), whether the employee:

    (i) Is unable to perform work of any kind;

    (ii) Is unable to perform any one or more of the essential functions 

of the employee's position, including a statement of the essential 

functions the employee is unable to perform (see Sec.  825.115), based 

on either information provided on a statement from the employer of the 

essential functions of the position or, if not provided, discussion with 

the employee about the employee's job functions; or

    (iii) Must be absent from work for treatment.

    (5)(i) If leave is required to care for a family member of the 

employee with a serious health condition, whether the patient requires 

assistance for basic medical or personal needs or safety, or for 

transportation; or if not, whether the employee's presence to provide 

psychological comfort would be beneficial to the patient or assist in 

the patient's recovery. The employee is required to indicate on the form 

the care he or she will provide and an estimate of the time period.

    (ii) If the employee's family member will need care only 

intermittently or on a reduced leave schedule basis (i.e., part-time), 

the probable duration of the need.

    (c) If the employer's sick or medical leave plan requires less 

information to be furnished in medical certifications than the 

certification requirements of these regulations, and the employee or 

employer elects to substitute paid sick, vacation, personal or family 

leave for unpaid FMLA leave where authorized (see Sec.  825.207), only 

the employer's lesser sick leave certification requirements may be 

imposed.