What an IHP NP EDT undertaking asks for — and how to autofill 014-4721-84 with my-id.ca
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 my-id.ca.
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 my-id.ca makes it faster
- Save it once. Store your name, registration, and billing details in your my-id.ca profile.
- Keep documents ready. Upload supporting documents to my-id.ca Files so you are not searching at form time.
- Autofill the form. Use the my-id.ca Chrome extension on a web form, or fill a PDF from your saved profile inside my-id.ca.
- Review and submit yourself through the official channel.
Why do it in my-id.ca
Related Ontario forms repeat the same personal details. Captured once in my-id.ca — stored in Canada, with AI on its own servers — every form starts mostly complete.
Frequently asked questions
- How is this different from form 014-4749-84?
- 014-4749-84 is the general IHP EDT undertaking; 014-4721-84 is for nurse practitioners.
- How does my-id.ca help?
- It autofills your name, address, and billing number across IHP and NP ministry forms.
- Do I also need SERT authorization?
- NP SERT participation may require form 014-4751-84 — confirm on ontario.ca.
Fill it once. Reuse it everywhere.
Save your information in my-id.ca once, then autofill this form and the next one — web forms with the Chrome extension, PDFs right in the app. Your data is stored in Canada and AI runs on my-id.ca's own servers, never sent to third-party AI providers.