Sign nurse practitioner EDT undertakings without retyping registration and contact details

Nurse practitioners participating in IHP Electronic Data Transfer complete a dedicated undertaking that repeats their legal name, registration number, practice address, and billing identifiers. This guide is an example of storing them once in hivi.

Official form and source

Start from the official source and always use the current version — form numbers and links can change:

• Service page: Claims submission — Resources for Physicians — ontario.ca
• Form (Central Forms Repository): IHP EDT Undertaking and Acknowledgement for Nurse Practitioners (NP) — 014-4721-84

What this form is about

Form 014-4721-84 is the IHP Electronic Data Transfer (EDT) Undertaking and Acknowledgement for Nurse Practitioners, used when NPs bill OHIP through IHP programs using electronic claims transmission.

Before you start: what to gather

• NP full legal name and practice address.
• College of Nurses registration and IHP billing number.
• Authorized contact phone and email.
• EDT software or vendor details — confirm on ontario.ca.

Confirm the current process on ontario.ca.

How hivi makes it faster

1. Save it once. Store your name, registration, and billing details in your hivi profile.
2. Keep documents ready. Upload supporting documents to hivi Files so you are not searching at form time.
3. Autofill the form. Use the hivi Chrome extension on a web form, or fill a PDF from your saved profile inside hivi.
4. Review and submit yourself through the official channel.

Why do it in hivi

Related Ontario forms repeat the same personal details. Captured once in hivi — stored in Canada, with AI on its own servers — every form starts mostly complete.