The Family and Medical Leave Act (FMLA) is a benefit that allows qualified employees to have up to 12 weeks of leave per fiscal year. The law allows eligible employees to take job-protected leave for the birth or adoption of a child, for the care of a child, spouse or parent with a serious health condition, for the employee’s own serious health condition, or for the care of a covered military service member.

The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Eligible employees are entitled to:

Twelve workweeks of leave in a 12-month period for:

* the birth of a child and to care for the newborn child within one year of birth;
* the placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement;
* to care for the employee’s spouse, child, or parent who has a serious health condition;
* a serious health condition that makes the employee unable to perform the essential functions of his or her job;
* any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty;” or

Twenty-six workweeks of leave during a single 12-month period to care for a covered servicemember with a serious injury or illness if the eligible employee is the servicemember’s spouse, son, daughter, parent, or next of kin (military caregiver leave).

WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition
WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition