| Details | |
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| Number | INS5216 |
| Title | INS5216A: Authorization to Release a Medical Certificate for Employment Insurance Compassionate Care Benefits, INS5216B: Medical Certificate for Employment Insurance Compassionate Care Benefits |
| Purpose | INS5216A: Have this form completed by the patient or their legal representative authorizing the medical doctor or nurse practitioner to complete the medical certificate for Compassionate Care benefits. INS5216B: Have this form completed by a medical doctor or nurse practitioner if you are asking for Compassionate Care benefits. You must return these 2 forms together by mail or deliver them to your local Service Canada Centre. Please note that the fees requested by your doctor to complete these forms are entirely at your own expense. |
| Group | Employment Insurance |
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Important Information Returning the Form | |
| Forms |
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Authorization to Release a Medical Certificate PDF: SC-INS5216A, 106 KB, printed on 1 pages (8.5 x 11) |
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Medical Certificate for Employment Insurance (EI) Compassionate Care Benefits PDF: SC-INS5216B, 148 KB, printed on 2 pages (8.5 x 11) |
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