The Aao Transfer form is a vital document designed for patients undergoing orthodontic treatment who need to transition from one provider to another. This form facilitates the efficient sharing of pertinent patient information, ensuring continuity of care and treatment. To begin the process of transferring your records, please fill out the form by clicking the button below.
When navigating orthodontic treatment, the Aao Transfer form serves as an essential tool for ensuring a seamless transition between providers, particularly when a patient needs to change orthodontists during ongoing treatment. This form captures crucial patient information, including personal details such as name, birth date, and contact information, alongside a comprehensive analysis of the patient's condition and treatment progress. It encompasses key sections where past and present treatment plans, patient concerns, and notes on special health considerations can be documented. Information regarding appliances used, treatment cooperation, financial transactions, and recommendations for continued care adds depth to the records being transferred. Furthermore, the form emphasizes the understanding that treatment fees may fluctuate with a change in providers, reminding patients to anticipate potential cost variations. The signing of the transfer authorization by both the current and new orthodontist facilitates a complete handover, ensuring that all pertinent records—including x-rays, photographs, and treatment progress notes—accompany the patient to their new provider. Overall, the Aao Transfer form not only simplifies the process of changing orthodontists but also ensures that patients receive the continuity of care they need for effective treatment outcomes.
AAO TRANSFER FORM
PATIENT IN ACTIVE TREATMENT
Date _______________
To ____________________________________________________
From __________________________________________________
Phone ___________________ Fax __________________ Email: __________________________________________________
Patient's name _______________________________________ Birth date ____________________ Sex _________________
Social Security # __________________________ Phone ___________________
Responsible party __________________________________ Relationship: ____________________
Home address __________________________City _________________ State/Province ____________ Zip code __________
ANALYSIS (Including significant history & TMD) ________________________________________________________________
________________________________________________________________________________________________________
PATIENT/PARENT CONCERNS RE: TX _______________________________________________________________________
SPECIAL HEALTH OR HISTORY CONCERNS ___________________________________________________________________
TREATMENT PLAN (Including chronology of treatment rendered) _________________________________________________
TREATMENT PROGRESS (Including chronology of treatment rendered)____________________________________________
APPLIANCES
Fixed appliance:
Type_______________ Manufacturer _____________ Type of bracket: metal or non-metal Variations__________
Date bands and/or brackets placed: Max_______ Mand _______ Bonding Agent _______ Cementing Agent _________
Current archwire size and type: Max ______________ Mand _________________
Intraoral elastics: dates initiated, size and direction_____________________ Hours requested______________________
Extraoral appliance:
Type________________ and dates initiated______________________ Hours requested ____________________________
Removable appliance:
Type and dates initiated______________________________ Hours requested _________________________
Clear tray appliance:
Manufacturer _______________ Total trays ______ Trays delivered______ Change interval __________________________
Case/Patient number______________________
PATIENT COOPERATION
Oral hygiene __________________________________________ Headgear _________________________________________
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© American Association of Orthodontists 2014
Elastics ______________________________________________ Clear trays _______________________________________
Appointments _________________________________________ Broken appliances ________________________________
Patient's attitude toward treatment ________________________________________________________________________
Suggestions for patient motivation _________________________________________________________________________
ACTIVE TX TIME ESTIMATES Original _________________________ Remaining _____ % of active treatment completed
RECOMMENDATIONS FOR CONTINUED TREATMENT __________________________________________________________
______________________________________________________________________________________________________
RECOMMENDATIONS FOR RETENTION _____________________________________________________________________
ADDITIONAL COMMENTS _______________________________________________________________________________
_____________________________________________________________________________________________________
FINANCIAL
Closed ______________ Open End (Fixed) _______________Other ______________________
Fees: Active _______________ Extras ______________________________________________
Terms ________________________________________________________________________
Third party payment ____________________________________________________________
Total charges before transfer _________________________
Total amount paid before transfer _____________________
Unpaid amount still owed transferring office ____________
Balance of original quoted fee not yet charged ______________ or overpaid at transfer ______________
This patient/parent has been advised that orthodontic treatment fees vary widely throughout the country and the world and it is reasonable for them to expect that a transfer may increase treatment fees and may involve changes in payment policies. For most people who transfer during their orthodontic treatment, the total treatment cost is likely to increase.
AVAILABLE RECORDS FOR TRANSFER
Casts
Initial
Date ________
Progress Date ________ Articulator type________
Ceph
Initial Date ________
Progress Date ________
Tracings
Panoramic
CBCT
Intra-oral scan
files
Intraoral x-rays
Facial photos
Intraoral photos
Check appropriate status of records:
Record duplicates sent upon request (may be an additional charge to patient) Yes No
Records enclosed Yes No Records sent under separate cover Yes No
Signature: __________________________________________________Date_______________________
(Orthodontist)
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REQUEST TO TRANSFER RECORDS TO NEW PROVIDER
When a patient moves, or, for other reasons, there is a necessity to change orthodontists during the course of ongoing orthodontic treatment, it is highly advantageous for all involved parties that the transfer be as prompt and convenient as possible. Of paramount importance is the identification of an orthodontist who will accept the patient and successfully complete the treatment.
The American Association of Orthodontists represents over ninety percent of the orthodontic specialists in the U.S. and Canada. Your current doctor is a member and will assist you in finding a qualified orthodontist.
It is necessary that your records be transferred to assure that the receiving orthodontist is knowledgeable of your orthodontic condition(s), orthodontic treatment goals, the current treatment plan, and related financial arrangements. To facilitate the transfer of these records, it is necessary that you complete the following:
I authorize Dr. ____________________ to release all records of ____________________ (patient’s name) for the
purpose of continuation of treatment by Dr. ___________________(new provider’s name).
Signature: __________________________________________________________Date_______________________
(Patient or Guardian)
Print Name ________________________________________
Relationship to Patient ______________________________
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Once the Aao Transfer form is completed, it is important to ensure that all necessary information is accurate and submitted on time. This will help facilitate a smooth transition to the new orthodontist and ensure continuity of care.
What is the AAO Transfer Form?
The AAO Transfer Form is a document used when a patient needs to switch orthodontic providers. This form helps in transferring important patient information, including treatment history and current progress, to ensure that the new orthodontist has all the necessary details for ongoing care.
Why would I need to complete this form?
If you find it necessary to change orthodontists during your treatment, this form is crucial. It allows your current provider to share vital information with the new provider, ensuring a smooth transition. Proper documentation helps avoid any gaps in your treatment plan.
What information is required on the form?
The form includes details such as patient demographics, current treatment progress, any appliances used, and financial information. Additionally, there are sections for patient concerns and recommendations for continued treatment.
Will my treatment costs change when I transfer?
Yes, it is common for treatment costs to vary when transferring. Fees can differ significantly between orthodontists. It's important to discuss financial arrangements with the new provider to understand any potential changes.
How are my records sent to the new provider?
Your current orthodontist will send your records directly to the new provider. The transfer can be done promptly by completing the form and authorizing the release of your information. You can also request copies of your records for your own use if needed.
What if I have concerns about my treatment during the transfer?
If you have concerns, it’s best to address them directly on the form. There’s space to write about any worries you have regarding your treatment or any specific issues you've encountered. Open communication is key to ensuring your new orthodontist can meet your needs.
How do I know if my new orthodontist is qualified?
The American Association of Orthodontists can help you find a qualified orthodontist. Your current provider may also offer recommendations. It’s important to ensure that your new provider has experience with similar cases to yours.
When completing the AAO Transfer form, it is common for individuals to overlook certain details, which can lead to complications in the transfer process. One frequent mistake involves missing or incorrect contact information. The form requires precise details such as phone numbers and email addresses for both the sending and receiving parties. If these are not accurately filled out, communication can be disrupted, potentially resulting in delays or miscommunication regarding the patient’s treatment.
Another common error is the incomplete or vague responses in the treatment plan and progress sections. The form outlines specific aspects of the patient's treatment history, including significant concerns and updates on progress. Failing to provide comprehensive information here could leave the new provider without critical context about the treatment's status. This gap can hinder their ability to effectively continue treatment, impacting the patient’s care.
Furthermore, people often neglect to thoroughly review the financial section of the form. It is essential to clarify outstanding balances, charges, and any potential financial obligations that may transfer over with the patient. Inaccuracies in this section can lead to confusion about costs and payment responsibilities, which can strain the relationship between the patient and the new orthodontist.
Lastly, overlooking the signature and date requirement is a mistake that can halt the entire transfer process. Without the necessary authorization from the patient or guardian, the new provider cannot access the patient’s records. Ensuring that all required signatures are present is crucial for a smooth transition, allowing the new orthodontist to begin treatment without unnecessary delays.
When changing orthodontic providers, certain documents complement the AAO Transfer Form. These documents help ensure a smooth transfer of essential information to the new orthodontist, thus facilitating continuity of care.
Collectively, these documents ensure that the new orthodontic provider is equipped with comprehensive information, facilitating a seamless transition process for the patient. Effective communication and information sharing between orthodontists are vital to maintaining quality care.
Referral Form: Similar to the AAO Transfer form, a referral form is used to transfer a patient from one healthcare provider to another. It typically includes patient information, treatment history, and the reason for the referral to ensure continuity of care.
Medical History Form: Both documents gather patient information, such as medical background and any current treatments. They are essential for understanding a patient's needs and creating a comprehensive treatment plan.
Treatment Record: This documents the ongoing treatment process and notes any changes. It allows new providers to assess what has been done and what is needed moving forward, similar to the treatment plan section of the AAO Transfer form.
Patient Consent Form: Just like the AAO Transfer form, this document gathers signatures for various necessary actions. It ensures that patients consent to share their information, providing legal protection for healthcare providers.
Insurance Claim Form: This form collects financial information, much like the financial section in the AAO Transfer form. It helps in understanding the patient’s insurance coverage and any outstanding balances related to their treatment.
Continuity of Care Form: Used when transitioning a patient to another provider, this document helps ensure that essential information about the patient’s treatment and history is communicated effectively, just like the details required in the AAO Transfer form.
When filling out the AAO Transfer form, consider the following do's and don'ts:
Misconceptions regarding the Aao Transfer form can lead to confusion among patients. Here are nine common misunderstandings and clarifications for each.
Understanding these misconceptions can aid patients in navigating the transfer of their orthodontic care more effectively.
Understanding the AAO Transfer Form is crucial for a smooth transition in orthodontic care.
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