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Tell us about your signing authority.

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Primary Contact Information.

I am a primary contact responsible for account management for the organization's telemedicine services, including the approval of any fees associated with the use of OTNhub services when adding new users

Organization Name

Postal Code

Registered Primary Practice Address

Other

Enter registered primary practice address

City

Province

Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territory Nunavut Ontario Prince Edward Island Quebec Saskatchewen Yukon

LHIN

- Please select - 0 - Outside Ontario 1 - Erie St. Clair 2 - South West 3 - Waterloo Wellington 4 - Hamilton Niagara Haldimand Brant 5 - Central West 6 - Mississauga Halton 7 - Toronto Central 8 - Central 9 - Central East 10 - South East 11 - Champlain 12 - North Simcoe Muskoka 13 - North East 14 - North West

OTN is now a part of Ontario Health (OH). OH requests business contact information during the OTNhub sign-up process. OH uses this information to support onboarding, validation and account management. Your business contact information may be provided/published to program delivery partners, other OTNhub member organizations, and OTNhub users to support account management or to respond to virtual care coordination questions.

Legal First Name

Legal Last Name

Middle Initial

Preferred First Name

Preferred Last Name

Job Title

Business Email

Business Phone

Ext

Business Fax

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Apply for additional healthcare professional user accounts

You can provide up to 30 additional users on this application form. Each new user will be required to accept the User Agreements via the OTNhub. Service accounts are associated with individual email accounts. Shared accounts are not permitted under the service agreement.

Ontario Health (OH) requests business contact information during the OTNhub sign-up process. OH uses this information to support onboarding, validation and account management. The business contact information provided may be published on the OTNhub Directory. In certain situations, the contact information may be disclosed to patients who call Ontario Health with non-technical questions about specific virtual care events you coordinate.

New userx

Error:

Profession

- Please select - Allied Health Professional Health Care Administrator (non-clinical) Medical Resident / Fellow Medical Student Midwife Nurse Physician Technical Support Telemedicine Coordinator: Clinical Telemedicine Coordinator: Non-Clinical

Nurse Category

Registered Nurse (RN) Registered Practical Nurse (RPN) Nurse Practitioner (NP)

Professional Registration Number

Validate

User information is being retrieved

Please wait while we retry retrieving user information...

There seems to be an issue retrieving user information. Please enter user information manually to proceed with the signup.

Legal First Name

Legal Last Name

Middle Initial

Registered with

- Please select - Board of Directors of Drugless Therapy – Naturopathy College of Audiologists and Speech-Language Pathologists of Ontario College of Chiropodists of Ontario College of Chiropractors of Ontario College of Dental Hygienists of Ontario College of Dental Technologists of Ontario College of Denturists of Ontario College of Dietitians of Ontario College of Massage Therapists of Ontario College of Medical Laboratory Technologists of Ontario College of Medical Radiation Technologists of Ontario College of Midwives of Ontario College of Nurses of Ontario College of Occupational Therapists of Ontario College of Opticians of Ontario College of Optometrists of Ontario College of Physicians and Surgeons of Ontario College of Physiotherapists of Ontario College of Psychologists of Ontario College of Respiratory Therapists of Ontario Ontario College of Pharmacists Ontario College of Social Workers and Social Service Workers Royal College of Dental Surgeons of Ontario Other

Registered with Text

Clinical Specialty

- Please select - Anaesthesiology Anatomical Pathology Cardiac Surgery Cardiology Cardiothoracic Surgery Clinical Immunology and Allergy Clinical Pharmacology Colorectal Surgery Community Medicine Critical Care Medicine Dermatology Diagnostic Radiology Emergency Medicine Endocrinology and Metabolism Family / General Practice Medicine Gastroenterology General Pathology General Surgery General Surgical Oncology Geriatric Medicine Gynecologic Oncology Gynecologic Reproductive Endocrinology and Infertility Hematological Pathology Hematology Infectious Diseases Internal Medicine Maternal Fetal Medicine Medical Biochemistry Medical Genetics Medical Microbiology Medical Oncology Neonatal-Perinatal Medicine Nephrology Neurology Neuropathology Neuroradiology Neurosurgery Nuclear Medicine Obstetrics and Gynecology Ophthalmology Orthopedic Surgery Otolaryngology Palliative Medicine Pediatrics Pediatric Anaesthesiology Pediatric Cardiac Surgery Pediatric Cardiology Pediatric Cardiothoracic Surgery Pediatric Dermatology Pediatric Development Pediatric Endocrinology and Metabolism Pediatric Gastro-Enterology Pediatric General Surgery Pediatric Hematology Pediatric Immunology and Allergy Pediatric Nephrology Pediatric Neurology Pediatric Neurosurgery Pediatric Ophthalmology Pediatric Orthopedic Surgery Pediatric Otolaryngology Pediatric Plastic Surgery Pediatric Psychiatry Pediatric Radiology Pediatric Respirology Pediatric Rheumatology Pediatric Thoracic Surgery Pediatric Urology Pediatric Vascular Surgery Physical Medicine and Rehabilitation Plastic Surgery Psychiatry Radiation Oncology Respirology Rheumatology Thoracic Surgery Trauma Medicine Urogynaecology Urology Vascular Surgery Other - Please select - Alternative Healing Therapy Assistant Occupational Therapy Assistant Physiotherapy Assistant Therapy Audiology CAN/RNA/LPN/RPN Nursing Cast Technology Chipodiatry Chiropractry Dental Hygiene Technology Dental Surgery Dentistry Dentistry Group Denturology ECG Technology Endodontistry Home Support/Care Work Therapy Kinesiology Lab Technology Language Interpretation Therapy Massage Therapy Medical Physics Midwifery Naturopathy Nuclear Medicine Technology Nurse Aide/Healthcare Aide Nursing Nurse Practitioner (stored as Profession Classification) Nursing Group Nutritional Therapy Occupational Therapy Optometry Oral Pathology Oral Radiology Oral Surgery Ortho/Prosthetic Therapy Orthodontistry Orthotics Osteopathy Paedodontistry Pediatric Dentistry Pediatric Oral Surgery Periodontistry Pharmacy Pharmacy Assistant Service Physician's Assistant Service Physiotherapy Podiatry Podiatry/Chiropody Group Prosthetics Psychology Psychotherapy Radiotherapy Recreation Therapy Rehabilitation Counseling Therapy Rehabilitation Engineering Therapy Rehabilitation Therapy Respiratory Therapy RN (stored as Profession Classification) RPN (stored as Profession Classification) Social Work Speech Language Pathology Spiritual Counseling Therapy Technician Group Technician Ophthalmology Therapy Group Vocational Rehab Counseling Therapy X-ray Technology Other

Clinical Specialty Text

OHIP Billing Number

Business Email

Business Phone

Ext

Are you applying for additional OTN Services?

Telederm

Emergency Service

Telestroke Intensive Care Teleburn Other

What service would you like to get started with?

- Please select - eVisit eConsult Scheduling Telederm Home video visits Specialists and Services Directory - Please select - eVisit eConsult Scheduling Telederm Home video visits Specialists and Services Directory - Please select - eVisit Scheduling

Do you have a ONE® ID account?

Yes No

Your ONE® ID username

Identity Authentication

A representative from Ontario Health will contact you to set up an appointment to complete the identity validation and set up your ONE ID account.

Click here to read more information about ONE ID.

Preferred Appointment Time

- Select a time - 7:00 a.m. 7:30 a.m. 8:00 a.m. 8:30 a.m. 9:00 a.m. 9:30 a.m. 10:00 a.m. 10:30 a.m. 11:00 a.m. 11:30 a.m. 12:00 p.m. 12:30 p.m. 1:00 p.m. 1:30 p.m. 2:00 p.m. 2:30 p.m. 3:00 p.m. 3:30 p.m. 4:00 p.m. 4:30 p.m. 5:00 p.m. 5:30 p.m.

Alternative Appointment Time

- Select a time - 7:00 a.m. 7:30 a.m. 8:00 a.m. 8:30 a.m. 9:00 a.m. 9:30 a.m. 10:00 a.m. 10:30 a.m. 11:00 a.m. 11:30 a.m. 12:00 p.m. 12:30 p.m. 1:00 p.m. 1:30 p.m. 2:00 p.m. 2:30 p.m. 3:00 p.m. 3:30 p.m. 4:00 p.m. 4:30 p.m. 5:00 p.m. 5:30 p.m.

Delegation Authority

Would the user like to authorize an administrator or nurse to act on to access and use their OTNhub services on their behalf? This person also needs to be registered with a ONE® ID before accessing the user's products and services.

Assign a delegate?

Yes No

 

Please provide the delegation authority's information:

 

Same as previous user's delegation authority

Legal First Name

Legal Last Name

Email

Phone

Ext

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Please review and confirm your information:

Thank you for completing your OTNhub application form.
Applicants will receive an email shortly with next steps.

Please do not attempt to log in to the OTNhub until we’ve sent you instructions.

For applicants with no ONE® ID accounts

A ONE® ID Local Registration Agent (LRA) will contact the applicants by email to confirm their appointment and provide the details to complete the identify validation via videoconference. Once completed, the applicants will receive ONE® ID credentials, and then login instructions from OTN.

For applicants with a ONE® ID account

The applicants level of assurance will be checked with Ontario Health for privacy and security. Applications will be processed within 1-2 business days. Once confirmed, OTN login instructions will be sent.

If you have not heard from us within the next 10 business days, please contact us at serviceactivation@otn.ca or call us at 1-855-654-0888.

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