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Get Aao Transfer Form in PDF

The AAO Transfer Form is a vital document used in the orthodontic field to facilitate the transfer of patient records between orthodontic providers. This form ensures that essential information regarding a patient's ongoing treatment is accurately conveyed, allowing for a seamless transition in care. By documenting treatment history, patient concerns, and financial arrangements, the form plays a crucial role in maintaining continuity of care for patients undergoing orthodontic treatment.

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The Aao Transfer form is an essential document designed to facilitate the seamless transition of orthodontic care from one provider to another. It captures vital patient information, including personal details such as name, birth date, and contact information, ensuring that the new orthodontist has a comprehensive understanding of the patient's history. The form also includes sections for detailing the patient's treatment progress, concerns, and any special health considerations that may affect ongoing care. Additionally, it outlines the treatment plan, including appliances used, cooperation levels, and financial arrangements related to the treatment. By documenting this information, the form helps to ensure that the new provider can continue the patient's care without interruption, maintaining continuity and addressing any specific needs or preferences. The importance of clear communication and record transfer is emphasized, as it not only aids in treatment efficacy but also helps manage expectations regarding potential changes in fees and policies. Ultimately, the Aao Transfer form serves as a critical tool in the orthodontic community, promoting patient-centered care during transitions between providers.

Dos and Don'ts

When filling out the AAO Transfer form, keep these important points in mind:

Provide accurate patient information, including full name and birth date.
Ensure the contact information for both the current and new orthodontist is complete.
Clearly outline the patient's treatment history and current status.
Include any special health or history concerns that may affect treatment.
Double-check the financial section for accuracy in fees and payments.
Sign and date the form to validate the request for record transfer.
Keep a copy of the completed form for your records.
Do not leave any required fields blank, as this may delay the transfer process.

Avoid these common mistakes:

Don’t forget to specify the new provider’s name.
Avoid using abbreviations that may confuse the recipient.
Do not omit details about the patient's cooperation and treatment progress.
Don’t ignore the importance of patient motivation suggestions.
Refrain from submitting incomplete or unclear records.
Do not wait until the last minute to complete the form.
Avoid making assumptions about what information is necessary; include all relevant details.
Do not overlook the need for a guardian's signature if the patient is a minor.

Document Attributes

Fact Name	Description
Purpose	The Aao Transfer Form facilitates the transfer of orthodontic records from one provider to another, ensuring continuity of care for patients in active treatment.
Patient Information	It collects essential patient details, including name, birth date, and contact information, to maintain accurate records during the transfer process.
Financial Considerations	The form outlines potential changes in treatment costs and payment policies, advising patients that transferring may increase their overall fees.
Record Transfer	Patients can authorize the release of their orthodontic records, which include treatment history and progress, to ensure the new provider is fully informed.
State-Specific Laws	In states like California, the transfer of medical records is governed by the California Civil Code Section 56.10, which ensures patient privacy and consent.
Additional Documentation	The form allows for the inclusion of various records, such as x-rays and treatment plans, to provide a comprehensive overview of the patient's orthodontic history.

Key takeaways

Filling out and using the AAO Transfer form is crucial for a smooth transition in orthodontic care. Here are some key takeaways:

Complete all sections: Ensure every part of the form is filled out accurately. Missing information can delay the transfer process.
Patient information: Include the patient's full name, birth date, and contact details. This helps in identifying the patient clearly.
Responsible party: Identify who is financially responsible for the treatment. This is often a parent or guardian.
Health concerns: Note any significant health or history concerns. This information is vital for the new orthodontist.
Treatment history: Provide a detailed treatment plan and progress notes. This helps the new provider understand the current status.
Appliance details: Specify any appliances used, including types and dates. This informs the new provider of the current treatment methods.
Patient cooperation: Describe the patient’s attitude and cooperation level. This can influence ongoing treatment strategies.
Financial details: Clearly outline any outstanding balances or fees. Transparency about costs is essential for both the patient and the new provider.
Record transfer: Indicate which records are being transferred. This ensures that the new provider has all necessary documentation.
Signatures required: Both the current provider and the patient (or guardian) must sign the form. This authorizes the transfer of records.

By following these guidelines, the transfer process can be efficient and effective, ensuring continuity of care for the patient.

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Example - Aao Transfer Form

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 ______________________________

Detailed Instructions for Writing Aao Transfer

Completing the AAO Transfer form is a crucial step when transitioning orthodontic care to a new provider. Accurate information ensures that the new orthodontist has all necessary details to continue treatment effectively. Follow these steps to fill out the form correctly.

Enter the date at the top of the form.
Fill in the name and contact information of the new provider.
Provide your current orthodontist's name and contact information.
Input the patient's name, birth date, sex, and Social Security number.
List the responsible party's name and relationship to the patient.
Complete the home address section, including city, state/province, and zip code.
Detail the patient's analysis, including significant history and TMD.
Document any patient or parent concerns regarding treatment.
Outline the treatment plan, including a chronology of treatment rendered.
Describe the treatment progress, again including a chronology.
Fill in details about any appliances used, including types and dates initiated.
Assess patient cooperation regarding oral hygiene, appointments, and attitudes toward treatment.
Estimate active treatment time, including original and remaining time.
Provide recommendations for continued treatment and retention.
Make additional comments if necessary.
Specify the financial status, including fees, charges, and any unpaid amounts.
Indicate the available records for transfer and check the appropriate status of records.
Sign and date the form at the bottom as the orthodontist.
Have the patient or guardian sign and date the authorization section.

Documents used along the form

When transferring orthodontic care, several additional forms and documents may accompany the AAO Transfer Form. Each document serves a specific purpose in ensuring a smooth transition between providers. Below is a list of common documents used in conjunction with the transfer process.

Patient Authorization Form: This document grants permission for the current orthodontist to release the patient’s records to the new provider. It typically includes the patient’s name, signature, and details about the new provider.
Insurance Information Form: This form collects details about the patient’s insurance coverage. It helps the new orthodontist understand the financial aspects of the treatment and any benefits available to the patient.
Room Rental Agreement: This essential document clarifies the arrangement between the landlord and tenant, detailing rights and responsibilities, similar to how a newyorkform.com/free-room-rental-agreement-template would provide a structured framework for room rentals.
Medical History Form: This document outlines the patient’s medical background, including any relevant health conditions or medications. It ensures that the new provider is aware of any factors that could affect treatment.
Treatment Progress Notes: These notes summarize the patient’s treatment to date, including any significant milestones or changes. They provide the new orthodontist with a clear picture of the patient’s current status.
Consent for Treatment Form: This form is required for the new provider to proceed with ongoing treatment. It confirms that the patient or guardian understands and agrees to the proposed treatment plan.
Financial Agreement: This document outlines the financial obligations related to the transfer and ongoing treatment. It details any outstanding balances and payment arrangements.
Transfer Summary Report: This report consolidates all essential information regarding the patient’s treatment and records. It serves as a comprehensive overview for the new provider.

Having these documents ready can facilitate a seamless transition for patients changing orthodontic providers. Each form plays a vital role in ensuring that the new provider has all the necessary information to continue effective treatment.