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8 form(s) found
Annex 5 - Compassionate Care Benefits (INS5217)
Employment Insurance
Complete this form if you are applying for Compasionate Care Benefits. This form must be submitted with the Authorization to Release a Medical Certificate (INS5216A) and the Medical Certificate for Employment Insurance Compasionate Care Benefits (INS5216B).
Authorization to Release a Medical Certificate for Employment Insurance (INS5216A)
Employment Insurance
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.
Authorization to Release a Medical Certificate for Employment Insurance Family Caregiver Benefits (INS5242A)
Employment Insurance
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.
INS5216A: Authorization to Release a Medical Certificate for Employment Insurance Compassionate Care Benefits, INS5216B: Medical Certificate for Employment Insurance Compassionate Care Benefits (INS5216)
Employment Insurance
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.
INS5242A: Authorization to Release a Medical Certificate for Employment Insurance Family Caregiver Benefits, INS5242B: Medical Certificate for Employment Insurance Family Caregiver Benefits (INS5242)
Employment Insurance
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.
Medical Certificate for Employment Insurance Compassionate Care Benefits (INS5216B)
Employment Insurance
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.
Medical Certificate for Employment Insurance Family Caregiver Benefits (INS5242B)
Employment Insurance
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.
Medical Certificate for Employment Insurance Sickness Benefits (INS5140)
Employment Insurance
Have this form completed by a medical doctor or other health practitioner acceptable to the Commission if you are unable to work due to illness, injury or quarantine. When you apply for sickness benefits, you will be asked to either submit the completed form or keep your completed medical certificate as we may ask you for it later.