The AAO Transfer Form is a pivotal document designed for the seamless transfer of a patient undergoing active orthodontic treatment from one orthodontist to another. It ensures the new orthodontist receives comprehensive information regarding the patient's treatment plan, treatment progress, and any special health considerations. For those looking to continue their orthodontic care without interruption, clicking the button below to fill out the form is the first step towards a smooth transition.
The AAO Transfer Form plays a crucial role in ensuring the smooth transition of orthodontic care when a patient needs to switch providers during active treatment. This comprehensive form, designed to facilitate the transfer of essential patient information between orthodontists, covers a wide range of data, including patient identification, a detailed treatment history, and any special health concerns that the new provider should be aware of. It also describes the specific orthodontic appliances used, treatment progress, and recommendations for continued treatment or retention strategies. Importantly, the form addresses patient cooperation aspects, estimates for the remaining active treatment time, and outlines the financial details associated with the transfer. By consolidating this information, the form aims to minimize disruptions in the patient's care and maintain the trajectory toward achieving the desired orthodontic outcomes. Additionally, it serves as a formal request for the transfer of records, underscoring the need for clear communication and consent between the patient, the current orthodontic provider, and the prospective one. This ensures a coordinated effort among all parties involved, emphasizing both the continuity of care and the patient's well-being throughout the treatment process.
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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Moving forward with an orthodontic treatment transfer requires careful documentation to ensure smooth continuation of care. Filling out the AAO Transfer Form is a straightforward process, yet needs attention to detail to provide the new orthodontic provider with all necessary information about the patient's treatment plan, progress, and specific needs. This ensures that the new provider is well-informed and can continue the treatment effectively. Follow the steps below carefully to complete the form accurately.
After completing and submitting this form, the next steps involve the current orthodontic office preparing and transferring the patient's records to the new provider. It's important for the patient or guardian to communicate with both orthodontic offices to confirm the transfer of records and discuss any changes in treatment plans, costs, or schedules. Attention to these details will help ensure a seamless transition and continuous, effective orthodontic care.
What is an AAO Transfer Form?
An AAO Transfer Form is a comprehensive document designed to facilitate the transfer of a patient's orthodontic treatment from one provider to another. It includes detailed information about the patient's treatment plan, progress, appliances used, patient cooperation, and any special health or history concerns. The form also outlines any financial aspects of the treatment and recommends plans for continued treatment and retention. Additionally, it serves to authorize the release and transfer of the patient's orthodontic records to the new provider.
Why is using an AAO Transfer Form important?
Using an AAO Transfer Form is crucial because it ensures a smooth and efficient transition between orthodontic providers. It helps the new orthodontist understand the specifics of the patient's ongoing treatment, including past procedures, current treatment status, and future treatment plans. This understanding is vital for continuing care effectively without unnecessary repetition of treatment phases. Moreover, it alerts the new provider to any special considerations regarding the patient's health history or treatment concerns.
How does an AAO Transfer Form address patient concerns regarding treatment?
The AAO Transfer Form includes a section specifically dedicated to patient or parent concerns regarding treatment. This ensures that any issues or expectations the patient has are communicated to the new provider, allowing for a more tailored and satisfying treatment experience. Addressing patient concerns proactively can enhance cooperation and satisfaction with the orthodontic care process.
What financial information is included in the AAO Transfer Form?
The form provides a detailed financial summary related to the patient's treatment. It records both the total charges incurred before the transfer and the amount already paid, as well as any outstanding balance owed to the transferring office. The form also notes the balance of the original quoted fee not yet charged or any overpayment at transfer. This financial transparently helps prevent misunderstandings and facilitates a clear agreement between the patient and the new orthodontic provider.
Can the AAO Transfer Form be used to transfer orthodontic records?
Yes, the latter part of the form acts as a consent for the release and transfer of orthodontic records. It requires signatures from the patient or guardian, authorizing the current orthodontist to release all relevant records to the new provider. This consent is essential for complying with privacy laws and for ensuring that the receiving orthodontist has all necessary information to continue the treatment effectively. The form specifies whether records are enclosed, sent under separate cover, or available upon request, ensuring all parties know how and when the records will be transferred.
Filling out the AAO Transfer Form can sometimes be confusing, and it’s easy to make mistakes if you're not paying close attention. One common mistake is not including the full range of contact information for both the transferring and the receiving orthodontists. This includes phone numbers, fax numbers, and email addresses. Accurate and comprehensive contact information ensures smooth communication and prompt transfer process.
Another area prone to errors is the section detailing the patient’s significant history and treatment progress. Sometimes, details are left out or not fully updated. It is crucial to provide a thorough summary of the patient's medical and treatment history, including any significant events or concerns that could impact ongoing care. This information helps the new orthodontist understand the patient's needs and how best to continue their treatment.
When it comes to patient cooperation details, the form demands an honest assessment, yet this is where inaccuracies often occur. If there's an overestimation of a patient's compliance with oral hygiene practices or appliance wear times, it can lead to misunderstandings about treatment progress and expectations with the new provider. A clear, honest evaluation ensures the receiving orthodontist has realistic expectations and can plan accordingly.
Financial information is yet another critical part of the transfer form that can sometimes be filled out incorrectly. It is essential to accurately report the treatment fees paid to date, as well as any outstanding amounts. This prevents any financial misunderstandings or disputes that could delay the treatment. Transparency regarding the financial aspect of treatment ensures a smooth transition for the patient and both orthodontic offices.
Last but not least, the instructions regarding the transfer of patient records need to be followed precisely. Options for transferring records such as “Records enclosed,” “Record duplicates sent upon request,” and “Records sent under separate cover,” must be clearly marked to inform the new provider of what they are receiving and what may require an additional request. Neglecting this detail can lead to incomplete information being transferred, potentially impeding the patient's continuing care.
When handling orthodontic care, especially during a transfer of care from one provider to another, it's crucial to ensure that all necessary documentation is in order. The AAO Transfer Form is a key document used to facilitate this process. However, several other forms and documents often accompany it to ensure a smooth transition and comprehensive understanding of the patient's medical history, treatment progression, and financial obligations. Below is a list of documents that frequently accompany the AAO Transfer Form.
Each of these documents plays a vital role in ensuring the patient's orthodontic care is continuous and effective when transitioning from one provider to another. Together, they offer a comprehensive view of the patient's oral health status, treatment expectations, and financial considerations, contributing to a seamless transfer process.
The AAO Transfer Form shares similarities with a Medical Records Release Form, primarily in its function of transmitting important data between healthcare providers. Much like the AAO Transfer Form allows for the seamless transition of orthodontic care by detailing a patient’s treatment history, current plan, and any special considerations, a Medical Records Release Form enables the transfer of a patient's comprehensive medical history to ensure continuity of care. Both documents serve to inform incoming practitioners about the patient’s past and present health status, ensuring that care is consistent and informed by previous treatments.
Another document akin to the AAO Transfer Form is the HIPAA Authorization Form, which is used to ensure that patient information is shared in compliance with privacy laws. Both documents involve the patient’s consent to share their personal health information with other parties, although the AAO Transfer Form is specific to orthodontic records while the HIPAA Authorization Form has a broader applicability across all types of medical information. The emphasis on legal and ethical considerations in the handling of sensitive patient information underlies the importance of both documents in protecting patient privacy.
The Patient Referral Form commonly used in various medical practices is also similar to the AAO Transfer Form, facilitating the referral of a patient from one specialist to another. Both forms contain critical information about the patient’s treatment history, diagnosis, and the recommended next steps, albeit serving slightly different purposes. While the AAO Transfer Form is utilized during the transition of care mid-treatment, a Patient Referral Form typically initiates a new consultation or service from a specialist, with both aiming to enhance the continuity and quality of patient care.
The Consent for Treatment Form, which is mandatory before starting any new medical or dental treatment, shares an overlap with the AAO Transfer Form in terms of obtaining informed consent from the patient or their guardian. The AAO Transfer Form includes sections that resemble a consent process, particularly in acknowledging the transfer of care and the potential changes in treatment plans and fees. While the Consent for Treatment Form is more focused on the specific treatment at hand, the AAO Transfer Form addresses consent in the context of transferring and continuing treatment with a new provider.
Lastly, the Treatment Plan Form, which outlines a patient’s proposed dental or medical treatment, including objectives, strategies, and costs, parallels the AAO Transfer Form. Both documents serve to keep the patient informed about their care trajectory, setting clear expectations for the treatment process. The AAO Transfer Form extends this principle by emphasizing the need for clear communication between orthodontic practitioners during a transfer of care, ensuring that the incoming provider is fully aware of the established treatment plan and progress to date.
When filling out the AAO Transfer form, it's important to be thorough and precise to ensure a smooth transition for the patient. Here is a list of things you should and shouldn't do:
Understanding the AAO Transfer Form is crucial for patients undergoing orthodontic treatment who need to change their treatment provider. There are several misconceptions about this form and its process:
It's just a formality without any real importance. This is incorrect. The form ensures that the new orthodontist receives all necessary information about the patient's treatment plan, history, and progress, ensuring continuity and quality of care.
The transfer will not affect the treatment's cost. This is often a misconception. The document clearly states that treatment fees can vary widely, and transferring treatment could lead to higher costs due to differences in treatment plans or office policies.
Any orthodontist can easily take over the treatment without these records. This is not advisable. For successful completion of treatment, the new orthodontist must fully understand the patient’s orthodontic condition and treatment history. The transfer form provides this comprehensive information.
The form is the only thing needed for a transfer. While essential, the success of a transfer also depends on effective communication and coordination between the current and the new orthodontist beyond just the information on the form.
All orthodontists accept transfer patients. Not all orthodontists may be willing or able to take on transfer cases, making it important for the current orthodontist to help find a qualified successor.
The patient's consent is not necessary for the transfer. This is incorrect. The form requires the signature of the patient or guardian to authorize the release and transfer of records, emphasizing the importance of patient consent in the process.
Transferring orthodontists is common and has no drawbacks. While transfers are sometimes necessary, they can involve challenges such as adjusting to new treatment approaches or financial policies. Effective transfer documentation mitigates these issues.
All records are automatically transferred with the form. The form specifies which records are available for transfer and requires explicit consent and action to send them, sometimes involving additional charges to the patient.
Digital records make the AAO Transfer Form unnecessary. Even in the age of digital records, the form provides a structured way to share critical information and ensure that digital records are correctly interpreted and integrated into ongoing treatment.
The form simplifies financial arrangements for the patient. While it does provide information about financial policies and past payments, new financial arrangements may need to be made with the new provider, and overall treatment costs could increase.
It's essential for patients and their guardians to understand what the AAO Transfer Form entails and its significance in ensuring the continuity and success of orthodontic treatment after a change of providers.
When it comes to transferring orthodontic records and treatment responsibilities from one provider to another, a well-completed AAO Transfer Form is critical. Here are key takeaways to ensure the process is seamless and effective:
The AAO Transfer Form is designed to ensure a smooth transition of care by covering all bases from treatment details and patient compliance to financial matters and consent for record transfer. Filling out this form meticulously is in the best interest of all parties involved—primarily the patient, to maintain the continuum of care seamlessly between orthodontic providers.
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