Aao Transfer Template

Aao Transfer Template

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.

Content Overview

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 Sample

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

Initial

† Date ________

Progress † Date ________

Panoramic

Initial † Date ________

Progress † Date ________

CBCT

Initial † Date ________

Progress † Date ________

Intra-oral scan

Initial

† Date ________

Progress † Date ________

files

 

 

 

Intraoral x-rays

Initial

† Date ________

Progress † Date ________

Facial photos

Initial † Date ________

Progress † Date ________

Intraoral photos

Initial † Date ________

Progress † Date ________

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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© American Association of Orthodontists 2014

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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© American Association of Orthodontists 2014

Document Attributes

Fact Name Description
Patient Eligibility Patients must be in active treatment to use the AAO Transfer Form.
Document Requirements Transferring orthodontists must provide complete patient records, including treatment plans and progress.
Consent Requirement Patients or guardians need to sign the form to authorize the transfer of records.
Records Dispatch Records should be sent directly to the new provider for continuity of care.
Health History Importance Significant health histories must be disclosed to ensure proper treatment by the receiving orthodontist.
Financial Considerations Patients may incur increased fees if transferring, due to varying costs among orthodontic practices.
Record Types Included Records can include initial and progress casts, x-rays, and treatment histories.
Cooperation Expectations Patients should maintain appointments and follow care instructions to ensure a smooth transition.
State Laws Impact Transfer rules may vary by state. For instance, in California, the relevant law is the California Business and Professions Code § 17500.
Documentation Consent Permission for release of records must be specific and signed for legal compliance.

Aao Transfer: Usage Instruction

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.

  1. Date: Enter the current date.
  2. To: Write the name of the new orthodontist.
  3. From: Fill in your current orthodontist's name.
  4. Phone: Provide the current office phone number.
  5. Fax: Enter the fax number.
  6. Email: List the email address of the current orthodontic office.
  7. Patient's Name: Fill in the patient's full name.
  8. Birth Date: Provide the patient's date of birth.
  9. Sex: Indicate the patient's sex.
  10. Social Security #: Write the patient’s Social Security number.
  11. Phone: Enter the patient's phone number.
  12. Responsible Party: Fill in the name of the responsible party, if applicable.
  13. Relationship: Specify the relationship to the patient.
  14. Home Address: Enter the street address, city, state/province, and zip code.
  15. Analysis: Provide a summary of significant history and TMD.
  16. Patient/Parent Concerns RE: TX: Document any concerns regarding treatment.
  17. Special Health or History Concerns: Include any health issues or history that may be relevant.
  18. Treatment Plan: Outline the treatment plan, including the chronology of treatment rendered.
  19. Treatment Progress: Summarize the current status of treatment.
  20. Appliances: List details about fixed, extraoral, removable, and clear tray appliances being used.
  21. Patient Cooperation: Detail the patient's compliance with oral hygiene, appointments, and other relevant factors.
  22. Active TX Time Estimates: Provide original and remaining treatment time, along with percentage completed.
  23. Recommendations for Continued Treatment: Offer any suggestions for ongoing treatment.
  24. Recommendations for Retention: State any recommendations post-treatment.
  25. Additional Comments: Add any other relevant information.
  26. Financial: Fill in details regarding the financial status, including fees and payment information.
  27. Available Records for Transfer: Check the appropriate boxes for the records being transferred.
  28. Signature: The current orthodontist signs and dates the form.
  29. Request to Transfer Records: Authorize the release of records by filling in the necessary names and signatures.

Frequently Asked Questions

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

Common mistakes

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.

Documents used along the form

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.

  • Patient Authorization Form: This document allows the current orthodontist to release patient records to the new provider. It requires signatures from the patient or a guardian to ensure confidentiality and compliance with privacy regulations.
  • Patient Health History: This record outlines the patient's medical background, medications, and previous treatments. An accurate health history is crucial for the new orthodontist to make informed decisions about ongoing treatment.
  • Treatment Progress Notes: These notes detail the procedures that have already been performed, including any appliances used and the patient's response to treatment. They provide valuable insights into what has worked and what adjustments may be needed in the future.
  • Financial Agreement Document: This outlines the financial arrangements made between the patient and the previous orthodontist, including fees paid and any outstanding balances. Understanding these financial details helps the new provider plan for the patient's ongoing care.
  • Diagnostic Records: This set includes casts, X-rays, and treatment plans established previously. Such records are critical for the new orthodontist to evaluate the patient's current orthodontic status and to modify or continue the treatment plan effectively.

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.

Similar forms

  • 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.

Dos and Don'ts

When filling out the AAO Transfer form, consider the following do's and don'ts:

  • Do: Clearly write all provided information to ensure legibility.
  • Do: Include all relevant medical histories and current treatment plans.
  • Do: Provide accurate contact details for both the sending and receiving orthodontists.
  • Do: Check for any required signatures before submitting the form.
  • Do: Confirm the transfer records are complete and enclosed, if applicable.
  • Don't: Leave any sections blank unless specified; incomplete forms can cause delays.
  • Don't: Use abbreviations that may not be understood by the receiving orthodontist.
  • Don't: Forget to include the patient's name and date of birth on every page, if necessary.
  • Don't: Delay submitting the form, as prompt transfers facilitate better continuity of care.
  • Don't: Provide outdated documents; ensure all records are current and relevant.

Misconceptions

Misconceptions regarding the Aao Transfer form can lead to confusion among patients. Here are nine common misunderstandings and clarifications for each.

  • The form is optional. Some people believe that the Aao Transfer form is not necessary for transferring records. In fact, it is an essential document to ensure the continuity of treatment and communication between orthodontists.
  • Only new patients need the form. It may be assumed that the form is only relevant for new patients. However, existing patients entering a new orthodontic practice must also complete the form to provide necessary medical history and treatment information.
  • All records are automatically transferred. Some individuals think that all records will automatically follow them. The form must be properly completed to ensure that specific records are transferred, as not all records may be included without it.
  • Financial information is irrelevant. There is a misconception that financial details in the form are unimportant. Financial arrangements and outstanding balances must be communicated to avoid surprises in costs upon transfer.
  • There is a standard fee for all transfers. Many believe that the transfer fee is the same everywhere. Orthodontic practices may charge different amounts to transfer records, so it is wise to discuss this with both the current and new orthodontist ahead of time.
  • Submission of the form is the end of the process. Some assume that once the form is submitted, all is complete. Patients should follow up with both the current and new orthodontist to confirm that records have been received and reviewed.
  • Patient cooperation is irrelevant to the transfer. It may be thought that patient cooperation during treatment does not impact the transfer process. In reality, highlights of any compliance issues are important for the new provider to understand the history and current treatment progress.
  • The form does not require a signature. Some individuals may think that the form can be completed without a signature. Signatures from the patient or guardian are necessary to authorize the transfer of records.
  • Personal information is not protected. There may be a belief that personal data shared in the transfer process is not secure. In reality, the Aao Transfer form is designed to comply with privacy regulations to protect patient information.

Understanding these misconceptions can aid patients in navigating the transfer of their orthodontic care more effectively.

Key takeaways

Understanding the AAO Transfer Form is crucial for a smooth transition in orthodontic care.

  • Complete all sections accurately. Each part of the form collects essential information that helps the new orthodontist continue treatment effectively.
  • Include the patient's history and treatment progress. This information is vital for understanding the current status of orthodontic treatment.
  • Be aware of potential costs. Treatment fees can vary significantly between providers, so patients should expect potential changes in costs during the transfer.
  • Promptly authorize the transfer of records. This ensures that both the current and new orthodontists communicate effectively and that treatment can resume without delay.
  • Verify the status of records being sent. Ensure that you check the appropriate options regarding duplicates and whether records are enclosed or sent separately.

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