Fill in a Valid Aao Transfer Template

The Aao Transfer Form is a crucial document used when a patient needs to change orthodontic providers during active treatment. This form ensures that all necessary records and treatment details are seamlessly transferred to the new orthodontist, allowing for continuity of care. If you’re ready to fill out the form, click the button below!

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When a patient is undergoing orthodontic treatment and needs to transfer to a new provider, the Aao Transfer form plays a crucial role in ensuring a smooth transition. This comprehensive document captures essential information about the patient's treatment history, current progress, and any specific concerns that may affect ongoing care. Key sections include patient demographics, a detailed analysis of treatment rendered, and notes on patient cooperation and attitude towards treatment. Additionally, it outlines the treatment plan and progress, along with recommendations for continued care and retention. Financial details are also addressed, helping to clarify any outstanding fees or payment policies that may change with the transfer. By providing a thorough overview of the patient's journey, the Aao Transfer form helps the new orthodontist understand the case quickly and effectively, ensuring that the patient receives uninterrupted care.

Aao Transfer Example

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 _________________________________________

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)

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 ______________________________

Click for Aao Transfer File

File Breakdown

Fact Name	Description
Purpose	The AAO Transfer Form is designed to facilitate the transfer of orthodontic records when a patient changes providers.
Patient Information	It collects essential patient details, including name, birth date, and contact information.
Active Treatment Status	The form indicates whether the patient is in active treatment, ensuring continuity of care.
Health Concerns	Special health or history concerns are documented to inform the new provider about potential issues.
Treatment Plan	The treatment plan section outlines the chronology of treatments already rendered.
Financial Information	Details about treatment fees, payment policies, and any outstanding balances are included.
Record Transfer	It specifies the records available for transfer, such as x-rays and progress notes.
Patient Cooperation	The form assesses the patient's cooperation and attitude towards their treatment.
Signature Requirement	A signature from the current orthodontist and patient or guardian is necessary for record transfer.
State-Specific Regulations	The governing laws for the transfer may vary by state, impacting how the form is utilized.

Guide to Using Aao Transfer

Filling out the AAO Transfer Form is a crucial step in ensuring a smooth transition of orthodontic care. This form collects essential information about the patient, their treatment history, and the current status of their care. Properly completing the form will help the new provider understand the patient's needs and facilitate continuity of treatment.

Date: Enter the current date in the designated space.
To: Fill in the name of the new provider.
From: Write the name of the current provider.
Phone: Include the current provider’s phone number.
Fax: Provide the current provider’s fax number.
Email: Enter the current provider’s email address.
Patient's Name: Fill in the full name of the patient.
Birth Date: Write the patient’s date of birth.
Sex: Indicate the patient’s sex.
Social Security Number: Provide the patient’s social security number.
Responsible Party: Enter the name of the person responsible for the patient’s treatment.
Relationship: Specify the relationship of the responsible party to the patient.
Home Address: Fill in the patient’s home address, including city, state/province, and zip code.
Analysis: Provide a detailed analysis, including significant history and TMD.
Patient/Parent Concerns: Describe any concerns regarding treatment.
Special Health or History Concerns: Note any relevant health concerns.
Treatment Plan: Outline the treatment plan and chronology of treatment rendered.
Treatment Progress: Document the progress made in treatment.
Appliances: Specify details about fixed, extraoral, removable, and clear tray appliances.
Patient Cooperation: Describe the patient’s cooperation regarding oral hygiene, appointments, and appliance care.
Active Treatment Time Estimates: Provide estimates for original and remaining active treatment time.
Recommendations for Continued Treatment: List any recommendations for ongoing care.
Recommendations for Retention: Include suggestions for retention post-treatment.
Additional Comments: Add any further comments that may be relevant.
Financial Information: Fill in details regarding the financial status of the treatment.
Available Records for Transfer: Indicate which records are available for transfer and their status.
Signature: The orthodontist should sign and date the form.
Request to Transfer Records: Fill in the required information regarding the authorization for record transfer.
Signature of Patient or Guardian: The patient or guardian must sign and date the authorization.
Print Name: Include the printed name of the person signing.
Relationship to Patient: Specify the relationship of the signer to the patient.

Get Answers on Aao Transfer

What is the purpose of the AAO Transfer Form?

The AAO Transfer Form is designed to facilitate the transfer of orthodontic records when a patient changes providers during their treatment. It ensures that the new orthodontist has all necessary information regarding the patient's treatment history, current status, and any specific concerns. This helps maintain continuity in care and allows the new provider to make informed decisions about the patient's ongoing treatment.

What information is required on the AAO Transfer Form?

The form requires several key pieces of information, including:

Patient's personal details, such as name, birth date, and contact information.
Details about the current treatment, including history, progress, and any appliances used.
Concerns from the patient or parent regarding treatment.
Financial information related to the treatment, such as fees and any outstanding balances.
Records available for transfer, like x-rays and treatment progress notes.

Completing all sections accurately ensures a smooth transition to the new provider.

How does the transfer process work?

To initiate the transfer, the patient or their guardian must complete the AAO Transfer Form and sign it, authorizing the release of records. The current orthodontist will then send the completed records to the new provider. This process is crucial for ensuring that the new orthodontist understands the patient's treatment history and can provide appropriate care. It is advisable to coordinate with both the current and new orthodontists to ensure a seamless transfer.

Will there be any changes in treatment costs after transferring?

Yes, transferring orthodontic care can lead to changes in treatment costs. Fees for orthodontic services vary widely across different providers and locations. Patients should be aware that their total treatment cost may increase when moving to a new orthodontist. It is essential to discuss financial arrangements with the new provider upfront to avoid any surprises later on.

Common mistakes

Filling out the AAO Transfer form requires attention to detail. One common mistake is omitting essential contact information. This includes the phone number, fax number, and email address of both the transferring and receiving orthodontists. Missing this information can delay the transfer process and hinder communication between offices.

Another frequent error involves inaccurate patient details. Patients often neglect to provide their full name, birth date, or Social Security number. Such omissions can lead to confusion and may complicate the transfer of records. Always double-check these critical pieces of information before submitting the form.

Inadequate descriptions in the treatment history section is also a mistake. Patients sometimes provide vague or incomplete information about their treatment progress and concerns. This lack of detail can prevent the new orthodontist from understanding the patient’s history and needs, potentially impacting the quality of ongoing care.

Some individuals fail to indicate the status of their financial arrangements. Whether the account is closed or open should be clearly marked. Missing this information can lead to misunderstandings regarding outstanding balances or payment policies, which can be frustrating for both the patient and the new provider.

Lastly, patients often overlook the section regarding available records for transfer. Not specifying which records are being sent can create uncertainty. It is crucial to check the appropriate boxes to ensure that all necessary documentation accompanies the transfer, facilitating a smooth transition for the patient.

Documents used along the form

When transferring orthodontic care, several documents are essential to ensure a smooth transition. Each of these forms plays a crucial role in maintaining continuity of care for the patient. Below are five important documents often used alongside the AAO Transfer form.

Patient Medical History Form: This document provides a comprehensive overview of the patient's medical background, including any allergies, previous surgeries, and current medications. It helps the new orthodontist understand the patient's health status and any potential concerns that may affect treatment.
Financial Agreement: This form outlines the financial arrangements made between the patient and the original orthodontist. It details the fees for treatment, payment plans, and any outstanding balances. This transparency helps the new provider understand the financial obligations involved.
Treatment Progress Notes: These notes summarize the treatment history, including procedures performed and the patient’s response to treatment. They are vital for the new orthodontist to assess the current status and plan the next steps effectively.
Consent for Treatment: This document confirms that the patient or guardian has agreed to the treatment plan and understands the associated risks. It’s important for the new provider to have this consent to continue care without legal complications.
X-rays and Imaging Records: These include any relevant imaging, such as panoramic x-rays, cephalometric x-rays, or intraoral scans. They provide crucial visual information that aids in diagnosis and treatment planning for the new orthodontist.

Having these documents ready can significantly ease the transition process for both the patient and the new orthodontist. It ensures that everyone involved is on the same page, leading to a more efficient and effective continuation of care.

Similar forms

Patient Referral Form: Similar to the AAO Transfer Form, the Patient Referral Form serves to transfer essential patient information between healthcare providers. It includes details about the patient's medical history, current treatment, and specific concerns that need to be addressed by the new provider.
Medical Records Release Form: This document allows patients to authorize the release of their medical records to another healthcare provider. Like the AAO Transfer Form, it ensures that the new provider has access to critical information necessary for continued care.
Continuity of Care Document (CCD): The CCD is a standardized document that summarizes a patient's health information and treatment history. It is similar to the AAO Transfer Form in that it provides a comprehensive overview of a patient’s ongoing treatment and medical background, facilitating seamless transitions between providers.
Insurance Authorization Form: This form is used to obtain approval from an insurance company for continued treatment. It parallels the AAO Transfer Form by outlining the patient's treatment plan and any associated costs, ensuring that the new provider understands the financial aspects of the patient's care.

Dos and Don'ts

When filling out the AAO Transfer form, attention to detail is crucial. Here are some important dos and don'ts to keep in mind:

Do ensure all personal information is accurate, including the patient's name and contact details.
Do provide a clear and concise treatment history to assist the new provider.
Do include any special health concerns that may affect treatment.
Do sign and date the form to authorize the transfer of records.
Do communicate any financial arrangements clearly to avoid misunderstandings.

Don't leave any sections blank; incomplete forms can delay the transfer process.
Don't provide outdated contact information for the new provider.
Don't forget to check the status of records to ensure they are sent as requested.
Don't omit details about the patient's cooperation and attitude towards treatment.
Don't hesitate to ask for help if you are unsure about any part of the form.

By following these guidelines, you can help ensure a smooth transition to the new orthodontist. Your attention to detail will aid in providing the best possible care for the patient during this important change.

Misconceptions

Misconception 1: The Aao Transfer form is only for patients who are unhappy with their current orthodontist.

This is not true. The form is designed for any patient who needs to transfer their records for various reasons, including relocation, changes in insurance, or even a change in personal circumstances. It facilitates continuity of care regardless of the reason for the transfer.
Misconception 2: Completing the Aao Transfer form guarantees that the new orthodontist will accept the patient.

While the form helps in transferring records, it does not ensure acceptance by a new provider. Each orthodontist has their own criteria for accepting new patients. It is advisable to confirm with the new orthodontist before initiating the transfer.
Misconception 3: The Aao Transfer form is a lengthy and complicated process.

In reality, the form is straightforward and designed to gather essential information efficiently. Most patients can complete it quickly, allowing for a smooth transition to the new provider.
Misconception 4: Transferring records will incur significant costs for the patient.

While there may be some fees associated with record duplication or transfer, these costs are generally minimal. It’s important for patients to discuss any potential fees with both their current and new orthodontists to avoid surprises.

Key takeaways

Completing the AAO Transfer Form is essential for ensuring a smooth transition between orthodontic providers. This form contains critical information about the patient's treatment history and current status.
Accurate patient information is crucial. Make sure to fill out all sections, including the patient's name, birth date, and contact details, to avoid any delays in treatment.
Include a detailed analysis of the patient's orthodontic condition. This should encompass significant history and any concerns related to temporomandibular disorders (TMD).
Document the treatment plan clearly. Outline the chronology of treatments rendered, including any appliances used and their specifications, to provide the new orthodontist with a comprehensive understanding of the case.
Be transparent about patient cooperation. Note any issues with oral hygiene, appliance use, and attendance at appointments. This information is vital for the new provider to tailor their approach.
Financial arrangements should be clearly stated. Indicate any outstanding balances and the total charges before the transfer to prevent misunderstandings regarding payment.
Familiarize yourself with the records being transferred. Check the status of all records, including initial and progress notes for various diagnostic tools, to ensure nothing is overlooked.
Finally, remember that transferring orthodontic care may result in changes to treatment fees and payment policies. Patients should be prepared for potential increases in costs associated with their ongoing treatment.