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The AAO Transfer Form serves a crucial function in the seamless continuity of orthodontic care when a patient, for various reasons, needs to change their orthodontist mid-treatment. This comprehensive document meticulously records a patient's active treatment details, including the date, the transferring and receiving orthodontist's contact information, and the patient's personal information such as name, birth date, sex, and social security number. Moreover, it delves into the specifics of the orthodontic analysis, highlighting any significant medical history, treatment plans with timelines of rendered services, and patient or parent's concerns regarding the treatment. The form also outlines the patient's cooperation level, the appliances used (fixed, clear trays, removable, or extraoral), and any recommendations for ongoing treatment or retention strategies post-transfer. Financial details, ensuring a transparent transition regarding the costs incurred and the balances owed or overpaid, are meticulously noted. Finally, it addresses the availability of vital records for transfer, ensuring the new provider has all necessary information to continue the patient's care effectively. With spaces provided for necessary authorization signatures, the AAO Transfer Form embodies a thorough approach to ensuring a smooth and informed transition between orthodontic providers, safeguarding the patient’s pathway to an optimal treatment outcome.

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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

File Attributes

Fact # Detail
1 AAO Transfer Form is used for patients in active orthodontic treatment who need to transfer to a new provider.
2 The form includes detailed patient information, such as name, birth date, and social security number.
3 Contains sections for analysis, including significant history and TMD (Temporomandibular Disorders) information.
4 It outlines patient/parent concerns regarding treatment, special health or history concerns, and the treatment plan.
5 Details on treatment progress, appliances used, and patient cooperation are required to ensure continuity of care.
6 Includes estimates of active treatment time remaining and recommendations for continued treatment and retention.
7 Provides a section for financial information related to the treatment, including fees and third-party payments.
8 Advises the patient/parent that orthodontic treatment fees may vary and that transferring could increase total treatment costs.
9 Lists available records for transfer, including casts, cephalometric analyses, panoramic and intra-oral scans, and various x-rays.
10 Includes a section for the request to transfer records to a new provider, requiring authorization signatures from the patient or guardian.

How to Fill Out Aao Transfer

Filling out the AAO Transfer Form is a critical step in ensuring a smooth transition of orthodontic care. This document facilitates the seamless transfer of vital information between orthodontists, ensuring the continuation of care is based on a comprehensive understanding of the patient's treatment history, special health concerns, and the overall treatment plan. The form also includes important details regarding financial arrangements and available records for transfer. Guidance through each section of this form is essential for accurate completion, making the process efficient for both the patient and the orthodontic practices involved.

  1. Start by entering the date at the top of the form.
  2. In the "To" section, write the name of the receiving orthodontist or orthodontic office.
  3. In the "From" section, fill out the name of the current orthodontist or orthodontic office providing the treatment.
  4. Provide the phone, fax, and email information of the current orthodontic office.
  5. Under "Patient's name," fill in the full name of the patient undergoing treatment.
  6. Enter the patient's birth date, sex, and Social Security number.
  7. Include a phone number where the patient can be reached, followed by the name and relationship of the responsible party, if applicable.
  8. Fill out the patient's home address including city, state/province, and zip code.
  9. In the "Analysis" section, describe any significant history and TMD (temporomandibular disorder) analysis.
  10. Document patient/parent concerns regarding treatment in the specified area.
  11. Detail any special health or history concerns that should be known.
  12. Under "Treatment Plan," provide an overview, including the chronology of treatment already rendered.
  13. Describe the treatment progress, following the same structure as the treatment plan section.
  14. Specifying information about the appliances used, including types, manufacturers, sizes, and any other relevant details.
  15. Assess the patient's cooperation, covering aspects like oral hygiene, use of headgear or elastics, and adherence to appointments and care instructions.
  16. Estimate the active treatment time, noting both the original and remaining durations along with the percentage completed.
  17. Provide recommendations for continued treatment and any notes on retention.
  18. Add additional comments as needed to convey information that might assist in the continuation of care.
  19. Detail the financial situation including fees for active treatment, extras, and terms. Note any third-party payments and the amounts paid or owed before transfer.
  20. Check off the available records for transfer and indicate their statuses.
  21. Sign and date the form in the designated "Signature" section.
  22. For the "REQUEST TO TRANSFER RECORDS TO NEW PROVIDER" section, authorize the release of records by entering the necessary patient, current doctor, and new provider information, then sign and date.

It's essential to double-check the form for accuracy before submission. Properly completing and submitting the AAO Transfer Form streamlines the process of changing orthodontists, ensuring that the new provider has all the necessary information to continue treatment effectively. Both patients and orthodontists benefit from the careful attention to detail during this transitional phase.

Frequently Asked Questions

What is an AAO Transfer Form?

The AAO Transfer Form is a document designed to assist in the transfer of a patient undergoing active orthodontic treatment from one orthodontist to another. This form ensures that all relevant information regarding the patient's treatment plan, progress, and any special considerations are effectively communicated between the outgoing and incoming treatment providers. It includes details such as the patient’s personal information, analysis of the orthodontic condition, treatment plan, progress, appliances used, patient cooperation, and financial information related to the treatment.

When is it necessary to use the AAO Transfer Form?

It becomes necessary to use the AAO Transfer Form when a patient in active orthodontic treatment needs to change their orthodontist. This situation might arise due to relocation, insurance changes, or the desire for a second opinion. The form is crucial for ensuring a smooth transition and continuity of care by providing the new orthodontist with comprehensive information about the patient's orthodontic history, treatment plan, and progress.

What information is required to complete an AAO Transfer Form?

To complete an AAO Transfer Form, the following information is required:

  1. Patient's name, birth date, social security number, and contact details.
  2. Details of the responsible party, including their relationship to the patient and contact information.
  3. Analysis of the patient’s orthodontic condition, including significant history and concerns.
  4. A detailed treatment plan, including types of appliances used and treatment progress.
  5. Financial information related to the orthodontic treatment, including fees and payment terms.
  6. Consent from the patient or guardian to release all records to the new orthodontic provider.

How can the transfer of records be requested?

To request the transfer of records, the patient or their guardian must provide written consent on the AAO Transfer Form. This consent authorizes the release of all orthodontic records to the new provider for the purpose of continuing treatment. The form should be signed by the patient or guardian, and the name of the new provider should be clearly stated. Additionally, it's important to check the appropriate status of records in terms of how they will be sent (enclosed, under separate cover, or upon request).

What should patients understand about transferring their orthodontic care?

Patients should understand that transferring their orthodontic care to a new provider can potentially increase the total treatment cost due to variations in treatment fees and payment policies across different practices. It is essential for patients to communicate effectively with both their current and new orthodontist to ensure that all parties are aware of the treatment needs and financial arrangements. Additionally, patients are advised to have realistic expectations regarding the continuity of care and to understand that the new provider may have different treatment approaches.

Common mistakes

Filling out the AAO Transfer Form is a crucial step in ensuring a smooth transition in orthodontic care, yet it is common for individuals to make mistakes during this process. One common error is neglecting to provide the complete contact information of both the transferring and receiving orthodontists. This includes the phone, fax, and email addresses, which are vital for seamless communication between the two offices. Without this information, the transfer of critical patient records can experience needless delays.

Another mistake often made is the omission of the patient's social security number and the responsible party’s name and relationship to the patient. These details are essential for correctly identifying the patient and ensuring that the right individual is billed for the ongoing treatment. Failing to include this information can lead to confusion and administrative issues, possibly even affecting the patient's treatment schedule.

Furthermore, individuals frequently fail to accurately detail the analysis section, particularly information regarding significant history and any temporomandibular disorders (TMD). This section is crucial for the receiving orthodontist to understand the patient’s background and the specifics of their treatment plan. Overlooking this can result in inadequate care that fails to address all of the patient's needs.

Mistakes in the section outlining the patient/parent concerns about treatment and special health history concerns are also common. This includes providing insufficient explanation about the patient's or parents' worries regarding the treatment, as well as failing to mention important health history that might affect the course of the orthodontic care. Such oversights can prevent the new orthodontic team from offering personalized, sensitive care tailored to the patient’s or family’s anxieties or health issues.

Errors in recording the treatment plan and progress, including the chronology of treatment rendered, can have significant repercussions. An accurate account of what has been done and what is planned is necessary for continuity of care. Omitting details about the appliances used, their dates of placement, and treatment progress can hinder the receiving orthodontist's ability to provide coherent follow-up care.

Another frequent oversight is not fully detailing patient cooperation, including oral hygiene practices, use of headgear, elastics, clear trays, and attendance at appointments, as well as any issues with broken appliances. Also, suggestions for motivating the patient are often missing. This information is critical for the new orthodontist to understand the patient's compliance and to continue encouraging positive behaviors for successful treatment outcomes.

Lastly, a critical error made by many is failing to accurately complete the financial information and available records for transfer sections. This should include details of any third-party payments, total charges before transfer, amount paid, and the balance still owed by or to the transferring office. Additionally, specifying which records are available for transfer and their respective statuses ensures that the receiving orthodontist has all necessary documentation to continue treatment effectively. Overlooking these details can lead to billing and treatment discrepancies that complicate the patient's transition and care continuity.

Documents used along the form

When transferring a patient's orthodontic care from one provider to another, which is facilitated by the AAO Transfer Form, several additional forms and documents often accompany this process to ensure a seamless continuation of care. These documents play a crucial role in providing the receiving orthodontist with comprehensive information about the patient's orthodontic history, current treatment status, and other pertinent details. By understanding these forms and their purposes, the transfer process can be made more efficient and effective.

  • Patient Consent Form for Release of Medical Information: This document is essential for authorizing the transfer of sensitive medical records between healthcare providers. It ensures that the process complies with patient privacy laws and regulations, including the Health Insurance Portability and Accountability Act (HIPAA). The form usually requires the patient's or guardian's signature.
  • Orthodontic Treatment Plan: A detailed outline of the planned orthodontic treatment, including objectives, procedures to be performed, estimated duration, and expected outcomes. This document provides the new orthodontist with a roadmap of the treatment strategy initially devised for the patient.
  • Medical and Dental History Form: This comprehensive form includes the patient's past and present medical and dental conditions, ongoing treatments, allergies, and medications. Understanding the patient's medical and dental history is critical for the new provider to safely continue orthodontic care.
  • Financial Agreement: A document that outlines the financial terms agreed upon by the patient or responsible party and the original orthodontic practice. It includes information about the treatment cost, payment plans, refunds, and insurance claims. The new orthodontist needs this information to understand and possibly continue or adjust the financial arrangements.
  • Progress Reports and Notes: Any notes or reports generated during the patient's treatment, including changes to the treatment plan, responses to treatment, and any incidents of non-compliance or issues with appliances. These documents offer insights into the patient's adherence to treatment protocols and any adjustments that have been made along the way.

Together with the AAO Transfer Form, these documents facilitate a comprehensive understanding of the patient's orthodontic journey, aiding the new orthodontist in providing continued, high-quality care. Not only do they ensure legal compliance and protect patient privacy, but they also serve to align the new provider with previous treatment plans and goals. Their significance in the patient transfer process cannot be overstated, ultimately contributing to the successful outcome of orthodontic treatment.

Similar forms

The AAO Transfer Form is quite similar to a Medical Records Release Form, which allows healthcare providers to share patient information with other physicians, specialists, or healthcare institutions. This similarity lies in the facilitation of continuous care and effective treatment planning by ensuring that the receiving party has access to the patient's previous medical or treatment records. Both documents serve to uphold the patient's best interest in receiving cohesive and informed care, irrespective of the healthcare provider.

Comparable to a Referral Form used within the medical community, the AAO Transfer Form serves a similar purpose in the seamless continuation of care. Typically, a Referral Form is filled out by a general practitioner or specialist to direct a patient to another healthcare professional for further treatment or consultation. In both cases, these documents ensure that the receiving professional is informed about the patient’s current condition and the rationale behind the referral or transfer.

Another document akin to the AAO Transfer Form is the Consent Form for Treatment, which is often required when initiating a new treatment or transferring care. This form ensures that the patient or their guardian is fully informed and agrees to the proposed treatment plan, including any risks or benefits associated with the treatment. Both documents are pivotal in safeguarding patient autonomy and informed consent throughout the healthcare journey.

The AAO Transfer Form also resembles the Dental Records Transfer Form that dentists use to share a patient's dental history and records with another dental practice. This similarity is based on the need for comprehensive knowledge of a patient's dental or orthodontic history to provide the best possible treatment. Like in orthodontics, prior information on treatments, x-rays, and ongoing care plans is crucial for continuity and success in dental care.

Similar to a Prescription Form used by medical professionals to order medication for a patient, the AAO Transfer Form is essential for ensuring that the new provider has all the necessary information to continue with an orthodontic treatment plan effectively. Both forms communicate critical information from one professional to another to maintain a patient's health regimen without interruption or error.

The Treatment Plan Document, typically used by healthcare providers to outline a patient's path to recovery, shares its core purpose with the AAO Transfer Form. It details the treatment strategies, goals, and progress expected or achieved, providing a blueprint for ongoing and future care. By transferring such detailed plans, healthcare providers ensure a uniform approach towards the patient’s treatment, minimizing the risk of disjointed care.

Last but not least, the AAO Transfer Form mirrors the functionality of an Insurance Claim Form to some extent. Though primarily used for billing and insurance purposes, an Insurance Claim Form contains detailed treatment information that can be crucial for a new provider taking over a case. Both forms play an integral role in the financial and treatment continuity for the patient, ensuring that the transition between providers does not hinder the patient's access to care or financial coverage.

Dos and Don'ts

Completing the AAO Transfer Form is a critical step in ensuring a seamless transition in orthodontic care. To help guide you through this process, here are essential do’s and don’ts to consider:

Do’s:
  • Ensure accuracy in all sections: Double-check all entries for accuracy, including patient information, treatment details, and financial records.
  • Provide comprehensive treatment details: Include a complete history of the treatment, noting any special health or history concerns that could impact ongoing care.
  • Clearly list the treatment progress: Detail the chronology of treatment received and any appliances used to offer the new provider a comprehensive view of the patient’s progress.
  • Include a thorough analysis: Ensure the previous diagnosis and any analysis, including significant history and TMD (if applicable), are well-documented.
  • Document patient or parent concerns: Note any concerns raised by the patient or their parent regarding the treatment to maintain open communication with the new provider.
  • Sign and date the form: Confirm that both the releasing and receiving orthodontists, as well as the patient or guardian, have signed and dated the form where required.
  • Prepare records for transfer: Check the appropriate boxes to clearly state which records are being sent and in what format they will be provided.
Don’ts:
  • Omit patient cooperation details: Do not skip detailing the patient’s cooperation with the treatment, as this can significantly impact ongoing and future treatment plans.
  • Ignore financial information: Avoid leaving the financial section incomplete. Ensure all charges, payments, and balances are up-to-date for a smooth transition.
  • Forget to list special instructions: Do not neglect to include any special instructions for patient motivation or unique treatment considerations crucial for continued care.
  • Assume records will transfer automatically: Do not assume that all necessary records will be transferred without specifying which ones and how they will be sent.
  • Leave sections blank: Refrain from leaving any section of the form blank. If a section does not apply, note it as "N/A" (not applicable).
  • Misspellings and inaccuracies: Avoid spelling mistakes and inaccuracies in both the patient’s and orthodontists’ details to prevent any confusion or miscommunication.
  • Delay in submission: Do not delay in completing and submitting the form. Timeliness is crucial to ensuring that the patient’s treatment continues without disruption.

Misconceptions

When transferring orthodontic care using an AAO Transfer Form, several misconceptions may arise. Understanding these misconceptions is crucial for patients and guardians navigating the process of changing orthodontists during active treatment. Here are ten common misconceptions clarified to assist in a smoother transition:

  1. Transferring will not impact the cost of treatment. This is often not the case. As indicated on the form, fees for orthodontic treatment can vary widely, and transferring to a new provider may lead to an increase in treatment costs.

  2. Any orthodontist can easily pick up where the last one left off. While this is the goal, the new orthodontist must review the patient’s history, treatment plan, and progress, requiring thorough communication and record transfer to ensure seamless continuity of care.

  3. Transferring orthodontic care is a quick process. The process requires gathering and transferring detailed records, which can take time. Both the releasing and receiving orthodontists must coordinate closely to ensure all necessary information is transferred efficiently.

  4. All records are automatically transferred. The form clearly asks for authorization to release records, indicating that this is a necessary step in the process that requires patient or guardian action.

  5. There are no additional charges for transferring records. Depending on the offices involved, there may be charges for copying and sending records. It's mentioned in the form that record duplicates sent upon request may have an additional charge.

  6. The treatment plan will remain exactly the same. The new orthodontist will review the patient’s case and may adjust the treatment plan based on their professional judgment and expertise.

  7. Payment policies and terms will not change. Each office has its own payment policies, and a transfer may involve changes in these policies, as well as adjustments to the financial agreement initially made with the original provider.

  8. Transferring orthodontic care is common and always suggested. While the form facilitates a transfer when necessary, transfers are generally not taken lightly due to the complexities involved in maintaining continuity and quality of care.

  9. The form is only for use within the United States. The American Association of Orthodontists (AAO) represents specialists in the U.S. and Canada, indicating the form applies to transfers in these countries.

  10. Oral hygiene and patient cooperation are not factors in the transfer. The form requests detailed information about the patient's cooperation, including oral hygiene and their attitude towards treatment. This information is crucial for the receiving orthodontist to understand the patient’s compliance and any challenges encountered.

Understanding these misconceptions helps patients and their families to navigate the complexities of transferring orthodontic care with realistic expectations and to prepare for the possible changes and adjustments that come with a new orthodontic provider.

Key takeaways

When you find yourself in a situation where transferring orthodontic care is necessary, understanding how to properly fill out and utilize the AAO Transfer Form is crucial. This form plays an essential role in ensuring a smooth transition between orthodontic providers. Here are four key takeaways you should be aware of:

  • Completing the transfer form fully and accurately is pivotal. It asks for detailed information about the patient including name, birth date, current treatment plans, and the progress of treatment up to that point. This thoroughness ensures the new provider has all they need to continue care effectively.
  • Ease of transfer and continuity of care are paramount. The form contains segments for both the transferring and receiving orthodontists, facilitating a seamless handover. The use of this form demonstrates a commitment to maintaining the quality and continuity of the patient's orthodontic treatment.
  • Financial transparency is assured through the form. It outlines any active fees, extras, terms, and amounts already paid or still owed. This transparency helps in managing expectations and mitigating any potential misunderstandings around financial obligations after the transfer.
  • The patient's consent for the release and transfer of records is a crucial requirement. The form includes a section where the patient or their guardian authorizes the transfer of their records to the new provider. This ensures that the transfer process respects patient confidentiality and complies with privacy regulations.

By following these guidelines, the transition to a new orthodontic provider can be made with confidence, knowing that every effort has been made to ensure a seamless continuation of care.

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