EI medical certificates for sickness and caregiving benefits

The three Service Canada medical certificates for Employment Insurance sickness, compassionate care and family caregiver benefits, and who can sign each one.

Service Canada has three medical certificates for Employment Insurance (EI). The Medical Certificate for EI Sickness Benefits (INS5140) attests that the patient cannot work for medical reasons, with the start date and expected duration. The compassionate care certificate (INS5216B) confirms that a family member has a serious medical condition with a significant risk of death within 26 weeks and needs care or support. The family caregiver certificate (INS5242B) confirms that an adult or child is critically ill or injured and needs care or support.

The two caregiving certificates need a medical doctor or nurse practitioner, while the sickness certificate has a wider list of signers. Each certificate goes to the patient or claimant. For a caregiving certificate, the patient or their legal representative first signs the authorization INS5257, and the claimant submits both together. All three are fillable PDFs in English and French. Vero Documents can fill all three from the visit note and the chart, ready for you to review and sign.

Employment Insurance

INS5140

Medical Certificate for Employment Insurance Sickness Benefits

Certificat médical pour les prestations de maladie de l'assurance-emploi

Attests that the patient cannot work for medical reasons, with the start date and expected duration of incapacity, for EI sickness benefits.

Completed by: Treating medical practitioner: medical doctor, nurse practitioner, or within their field a chiropractor, podiatrist, optometrist, psychologist, dentist or midwife; a registered nurse in isolated areas when no doctor is available
Format: Fillable PDF
Language: English and French

Official page PDF Version française How to fill it in

INS5216B

Medical Certificate for Employment Insurance Compassionate Care Benefits

Certificat médical pour des prestations de compassion de l'assurance-emploi

Certifies that a family member has a serious medical condition with a significant risk of death within 26 weeks and needs care or support, for EI compassionate care benefits (up to 26 weeks, shareable among caregivers).

Completed by: Medical doctor or nurse practitioner
Format: Fillable PDF
Language: English and French

Official page PDF Version française How to fill it in

INS5242B

Medical Certificate for Employment Insurance Family Caregiver Benefits

Certificat médical pour les prestations pour proches aidants de l'assurance-emploi

Certifies that an adult or child is critically ill or injured and needs care or support, with an estimated duration, for EI family caregiver benefits (up to 15 weeks for an adult, up to 35 weeks for a child under 18).

Completed by: Medical doctor or nurse practitioner
Format: Fillable PDF
Language: English and French

Official page PDF Version française How to fill it in

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A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Which EI certificate do I use for a seriously ill family member?

It depends on the prognosis. Use INS5216B for compassionate care benefits when the person has a serious medical condition with a significant risk of death within 26 weeks; those benefits last up to 26 weeks and can be shared among caregivers. If there is no such risk but the person is critically ill or injured and needs care or support, use INS5242B for family caregiver benefits: up to 15 weeks for an adult or 35 weeks for a child under 18.

Do I have to use form INS5140 for an EI sickness claim?

No, the form is optional. Service Canada accepts your own certificate if it is legible, on letterhead or with an official stamp, names the patient, gives the start date and expected duration if known, and is signed by hand, electronically or with a stamp. You must practise in Canada or the US, and the condition must be within your field.

Who can sign an EI sickness benefits certificate?

The treating medical doctor or nurse practitioner, or within their field a chiropractor, podiatrist, optometrist, psychologist, dentist or midwife. In isolated areas where no doctor is available, a registered nurse can sign. Service Canada does not reimburse the certificate; the practitioner may charge the patient. The patient keeps it for 6 years and, if Service Canada asks, uploads it in My Service Canada Account, mails it or brings it to an office.

How many compassionate care certificates do caregivers need?

One. A single INS5216B covers all the caregivers who share the benefit. For family caregiver benefits, the same INS5242B is used for adults and children, and if care is needed longer than you first estimated, the caregiver must submit a second signed certificate. A caregiver who is not related to the patient also submits a Family Member Attestation.