INS5216A: Authorization to Release a Medical Certificate, INS5216B: Medical Certificate for Employment Insurance Compassionate Care Benefits

Details
Number INS5216A-B
Title INS5216A: Authorization to Release a Medical Certificate, 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 to complete the medical certificate for compassionate care benefits.

INS5216B: Have this form completed by a medical doctor 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
Paper Size 8.5x11
Important Information
Returning the Form
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Authorization to Release a Medical Certificate
PDF, sc-ins5216a(2012-01-007)e.pdf, 607 KB, printed on 1 page

Medical Certificate for Employment Insurance Compassionate Care Benefits
PDF, sc-ins5216b(2012-01-007)e.pdf, 578 KB, printed on 1 page

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