A serious health condition means an illness, injury, impairment, or physical or mental condition that involves one of the following:
Category 1: HOSPITAL CARE
Inpatient Care (i.e., an overnight stay) in a hospital, or residential medical care facility, including any period of incapacity2 or subsequent treatment in connection with or consequent to such inpatient care.
Category 2: ABSENCE PLUS TREATMENT
A period of incapacity2 of more than three consecutive calendar days (including any
subsequent treatment or period of incapacity relating to the same condition),
that also involves:
Treatment3 two or more times by a health care provider, by a nurse or
physician’s assistance under direct supervision of a health care provider,
or by a provider of health care services (e.g. physical therapist) under orders
of, or on referral by, a health care provider; or
Treatment by a health care provider on at least one occasion which results in a
regimen of continuing treatment4 under the supervision of the health care
Category 3: PREGNANCY
Any period of incapacity due to pregnancy, or for prenatal care.
Category 4: CHRONIC CONDITIONS REQUIRING TREATMENTS
A chronic condition which:
Requires periodic visits for treatment by a health care provider, or by a nurse
or physician’s assistant under direct supervision of a health care provider;
Continues over an extended period of time (including recurring episodes of a
single underlying condition); and
May cause episodic rather than a continuing period of incapacity2 (e.g. asthma,
diabetes, epilepsy, etc.)
Category 5: PERMANENT/LONG-TERM CONDITIONS REQUIRING SUPERVISION
A period of incapacity2, which is permanent or long-term due to a condition for which treatment may not be effective. The employee or family member must be under the continuing supervision of, but need not be receiving active treatment by, a health care provider. Examples include Alzheimer’s, a severe stroke, or the terminal stages of a disease.
Category 6: MULTIPLE TREATMENTS(NON-CHRONIC CONDITIONS)
Any period of absence to receive multiple treatments (including any period of recovery therefrom) by a health care provider or by a provider of health care services under orders of, or on referral by, a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity of more than three consecutive calendar days in the absence of medical intervention or treatment, such as cancer, (chemotherapy, radiation, etc.), severe arthritis, (physical therapy), kidney disease (dialysis).
1Here and elsewhere on the form, the information sought relates only to the condition for which the employee
is taking FMLA leave.
2”Incapacity” for purposes of the FMLA, is defined to mean inability to work, attend school or perform other
regular daily activities due to the serious health condition, treatment thereof, or recovery therefrom
3Treatment includes examinations to determine if a serious health condition exists and evaluations of the
condition. It does not include routine physical examinations, eye examinations or dental examinations.
4A regimen of continuing treatment includes, for example, a course of prescription medication (e.g. an
antibiotic) or therapy requiring special equipment to resolve or alleviate the health condition. It does not
include the taking of over-the-counter medications such as aspirin, antihistamines or salves, or bed rest,
drinking fluids, exercise and other similar activities that can be initiated without a visit to a health care
Federal Register Form WH-380
Rules/Regulations, Vol. 60, No.4