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Legal Resources | Code of Regulations, Title 2 |    11098  

Certification Form.   

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For leaves involving serious health conditions, the employer may utilize the following Certification of Health Care Provider form or its equivalent. Employers may also utilize any other certification form, such as the United States Department of Labor Form WH-380, revised December 1994 (Certification of Health Care Provider/Family and Medical Leave Act of 1993), provided that the health care provider does not disclose the underlying diagnosis of the serious health condition involved without the consent of the patient.

Authority cited:

Government Code 12935(a)


Government Code 12945.2

29 U.S.C. 2601 et seq.

29 C.F.R. 825.

(Amended by Register 2013, No. 40.)