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The document is an authorization form for patients to allow medical doctors or nurse practitioners to release medical information necessary for claiming Employment Insurance (EI) Compassionate Care Benefits. It outlines the process for signing the form, including provisions for legally authorized representatives if the patient cannot consent. The document also details how personal information will be handled and retained by Employment and Social Development Canada (ESDC) in accordance with privacy laws.

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How to Use or Fill Out the Authorization to Release a Medical Certificate for Employment Insurance Form Online

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Click ‘Get Form’ to open it in the editor.
Begin by entering the patient's information. Fill in the last name, given names, date of birth, and home address including apartment number, street number and name, province or territory, city or town, postal or ZIP code, and country.
In the signature section, if the patient is able to consent, they should sign and date the form. If not, their legally authorized representative can complete this section by signing and providing their details.
Ensure that all required fields are filled out accurately. Review the information for any errors before submission.
Once completed, download or share the form directly from our platform to submit it along with the Medical Certificate for Employment Insurance Compassionate Care Benefits.

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