Form Wh-385-V - Certification For Serious Injury Or Illness Of A Veteran For Military Caregiver Leave (Family And Medical Leave Act) Page 2

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Part B: VETERAN INFORMATION
(1)
Date of the veteran’s discharge:
_____________________________________________________________________________________
(2)
Was the veteran dishonorably discharged or released from the Armed Forces (including the National Guard
or Reserves)? Yes
No
(3)
Please provide the veteran’s military branch, rank and unit at the time of discharge:
___________________________________________________________________________________________
(4)
Is the veteran receiving medical treatment, recuperation, or therapy for an injury or illness?
Yes
No
Part C: CARE TO BE PROVIDED TO THE VETERAN
Describe the care to be provided to the veteran and an estimate of the leave needed to provide the care:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Page 2
CONTINUED ON NEXT PAGE
Form WH-385-V Revised May 2015

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