[ Forms Catalogue ] [ Forms List ] [ Help ]

Form Detail

Details
Number INS5242B
Title Medical Certificate for Employment Insurance Family Caregiver Benefits
Purpose This form must be completed and signed by a medical doctor or nurse practitioner. To receive Employment Insurance (EI) family caregiver 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.
GroupEmployment Insurance
Important Information
Returning the Form

Forms
This site uses PDF form technology. To print these high-quality PDF forms, you must have a PDF reader installed. If you do not already have such a reader, there are several available on the Internet : Adobe Reader and Foxit Reader The form(s) are available in the following formats.
Service Canada (SC)

Medical Certificate for Employment Insurance Family Caregiver Benefits
PDF: SC-INS5242B, 237 KB, printed on 3 pages (8.5 x 11)

For more information, please consult the Forms Help page.