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Number INS5242
Title INS5242A: Authorization to Release a Medical Certificate for Employment Insurance Family Caregiver Benefits, INS5242B: Medical Certificate for Employment Insurance Family Caregiver Benefits
Purpose INS5242A: This form will be used to process claims for the Employment Insurance (EI) Family Caregiver benefit. The Authorization to Release a Medical Certificate for Employment Insurance Family Caregiver Benefits must be submitted by the EI claimant, along with the Medical Certificate for Employment Insurance Family Caregiver benefits, in order to access the Family Caregiver benefit. This form must be shown to the medical doctor or nurse practitioner who completes and signs the Medical Certificate for Employment Insurance Family Caregiver benefits. INS5242B:This form will be used to process claims for the Employment Insurance (EI) Family Caregiver benefit. The Medical Certificate for Employment Insurance Family Caregiver benefits must be submitted by the EI claimant in order to access the Family Caregiver benefit. The Medical Certificate must be completed and signed by a medical doctor or nurse practitioner.
GroupEmployment Insurance
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Authorization to Release a Medical Certificate for Employment Insurance Family Caregiver Benefits
PDF: SC-INS5242A, 107 KB, printed on 1 pages (8.5 x 11)

Medical Certificate for Employment Insurance Family Caregiver Benefits
PDF: SC-INS5242B, 215 KB, printed on 3 pages (8.5 x 11)

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