The Department of Labor's FMLA certification forms, plus the equivalent forms that leave administrators such as MetLife, Sun Life, Prudential and The Standard send to clinicians.
Employers may ask for a health care provider's certification before approving leave under the Family and Medical Leave Act. The Department of Labor's forms are the ones clinicians meet most: the WH-380-E for the employee's own serious health condition and the WH-380-F for a family member's. Military caregiver leave uses the WH-385 for a current servicemember and the WH-385-V for a veteran. The DOL forms are optional, and employers may use their own form asking for the same information.
On the DOL forms you complete only the health care provider section: Section II on the WH-380-E, Section III on the other three. The form goes back to the patient, who gives it to the employer; it is never sent to the DOL. 8 of the 25 forms here have a Spanish version, including all four DOL forms. When an insurer runs the leave, expect its own version, such as Sun Life's GAMSFM-11127. Vero Documents fills these PDFs from the visit note and the chart; you review and sign.
Certificado del proveedor de atención médica para la condición de salud grave de un empleado conforme a la Ley de Ausencia Familiar y Médica
Certifies the employee's own serious health condition, its onset, expected duration and the amount of FMLA leave (continuous, reduced schedule or intermittent) the employee needs.
Certificado del proveedor de atención médica para la condición de salud grave de un familiar conforme a la Ley de Ausencia Familiar y Médica
Certifies a family member's serious health condition and the care the employee needs to provide, supporting the employee's FMLA leave to care for that family member.
Certificado de lesión o enfermedad grave de un miembro actual del servicio para la licencia de cuidador militar conforme a la Ley de Ausencia Familiar y Médica
Certifies a current servicemember's serious injury or illness incurred or aggravated in the line of duty and the care needed, supporting up to 26 weeks of FMLA military caregiver leave for a family member.
Certificado para lesión o enfermedad grave de un veterano para la licencia de cuidador de un militar conforme a la Ley de Ausencia Familiar y Médica
Certifies a covered veteran's serious injury or illness (within five years of discharge) and the care needed, supporting FMLA military caregiver leave for a family member.
DIS-HCPC-FMLA-ESHCHealth care provider certifies the employee's serious health condition and the continuous/intermittent leave needed under FMLA, similar state laws or company leave administered by MetLife.
DIS-HCPC-FMLA-FMHCHealth care provider of the employee's family member certifies the serious health condition and care/leave needed for FMLA or state caregiver leave administered by MetLife.
PFML-CERT-FORMSingle multi-state certification for state paid family and medical leave claims administered or insured by MetLife (own condition, family care, bonding, military, safe leave, organ donation).
DIS-HCPC-FMLA-CSMHealth care provider certifies a covered service member's serious injury or illness for military caregiver leave under the FMLA administered by MetLife.
Health care provider certifies the employee's serious health condition, incapacity and continuous/intermittent leave needed under FMLA or state leave administered by NYL GBS Leave Solutions.
Family member's health care provider certifies the serious health condition and care the employee must provide, for FMLA/state leave administered by NYL GBS.
GP62712Treating provider certifies a serious health condition (own or family member) for a state PFML claim under a Principal private/equivalent plan.
GP62713Health care provider certifies a covered service member's serious injury or illness for PFML military caregiver leave (Colorado, Connecticut, Massachusetts) under a Principal plan.
Combined certification used when Prudential administers both the disability claim and FMLA/medical leave: diagnosis, pregnancy dates, incapacity and leave frequency.
Health care provider certifies the employee's serious health condition and leave needed for FMLA/state leave administered by Prudential.
Family member's health care provider certifies the serious health condition and care needed for FMLA/state family leave administered by Prudential.
Health care provider certifies the employee's own serious health condition and leave needed under the FMLA for leaves Sun Life administers.
Family member's health care provider certifies the serious health condition and care needed for a PFML caregiving claim under a Sun Life private plan.
Health care provider certifies the employee's own serious health condition for a state paid family and medical leave claim under a Sun Life private/equivalent plan.
Combined provider certification of a serious health condition (PFML) and short-term disability claim statement.
Health care provider certifies a current service member's serious injury or illness for FMLA military caregiver leave.
GAMSFM-11126Health care provider certifies a covered veteran's serious injury or illness for FMLA military caregiver leave.
Health care provider certifies a service member's serious injury or illness for PFML military caregiver leave under a Sun Life private plan.
Family member's health care provider certifies the serious health condition for a claim under a Sun Life Family Leave Insurance policy.
Family member's health care provider certifies the serious health condition and care needed for a state PFML caregiving claim under a private plan insured by The Standard.
Health care provider certifies the employee's own serious health condition and period of incapacity for state paid family and medical leave under a private/equivalent plan insured by The Standard.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
The employer must allow 15 calendar days to return the certification. You complete Section II, the health care provider part (Parts A to C, pages 2 to 4), and give the form back to the patient, who returns it to the employer. It is never sent to the Department of Labor. The WH-380-E is a 4-page fillable PDF in English and Spanish.
The servicemember's health care provider, who must be a DOD provider, a VA provider, or a TRICARE network or non-network authorized private provider. The provider completes Section III; the employer and the employee or servicemember complete Sections I and II. An employer may accept an invitational travel order or authorization instead. For a veteran discharged within five years, use the WH-385-V, where the provider may rely on VA determinations such as a disability rating.
Because employers may use their own certification form, and many hand leave administration to an insurer. MetLife (DIS-HCPC-FMLA-ESHC), New York Life Group Benefit Solutions (form 123767), Prudential (GL.2019.198) and Sun Life (GAMSFM-11127) each publish an equivalent of the WH-380-E, most with a matching family care version. Complete the form the patient brings, and include the claim number on each page where the insurer asks for it, as MetLife does.