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Ins5216a 2026
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- Click ‘Get Form’ to open the ins5216a in the editor.
- Begin with Section 1, 'PATIENT INFORMATION'. Fill in the patient's family name, all given names, and date of birth. Ensure that the residential address is complete, including apartment number, street, city, province/territory/state, country, and postal code if applicable.
- In Section 1, authorize the release of medical information by signing and dating the form. This step is crucial for allowing family members to claim Employment Insurance Compassionate Care Benefits.
- If the patient cannot consent due to illness, proceed to Section 2. Here, the legally authorized representative must print their name, state their relationship to the patient, and provide a contact telephone number.
- The representative must sign and date this section as well, confirming their authority to disclose medical information for completing the Medical Certificate.
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