Medical Certificate for Employment Insurance Compassionate Care Benefits - INS5216B
Purpose
Medical Certificate for Employment Insurance Compassionate Care Benefits This form must be completed and signed by a medical doctor or nurse practitioner. To receive Employment Insurance (EI) compassionate care benefits, the claimant must submit this form at the same time as the form INS5257 Authorization to Release Medical Information for Employment Insurance Compassionate Care or Family Caregiver Benefits.
Group
Employment Insurance
Forms
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Important Information
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Service Canada (SC)
Medical Certificate for Employment Insurance (EI) Compassionate Care Benefits
PDF: Download SC-INS5216B, 172 KB, printed on 3 pages (8.5 x 11)