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Aao Transfer Template

The AAO Transfer Form is a crucial document used when a patient needs to change orthodontic providers during ongoing treatment. It facilitates the transfer of essential medical records, ensuring that the new orthodontist has all the necessary information to continue care effectively. This form helps streamline the transition, allowing patients to maintain their treatment without unnecessary delays.

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The Aao Transfer form serves a crucial role in the continuity of orthodontic care when a patient needs to switch providers during active treatment. This form captures essential patient information, including demographics, medical history, and treatment progress. It outlines the patient's current treatment plan, detailing any appliances in use and their specifications, which helps the new orthodontist understand the ongoing treatment. The form also addresses patient cooperation and concerns, providing insights into the patient's attitude and any special health considerations that may affect treatment. Financial aspects are clearly laid out, indicating any outstanding balances or fees that may transfer to the new provider. Additionally, it includes a section for transferring relevant records, ensuring that the new orthodontist has all necessary documentation to continue care seamlessly. By facilitating communication between the current and new orthodontic offices, the Aao Transfer form aims to minimize disruptions in treatment and enhance patient outcomes.

Key takeaways

The AAO Transfer Form is essential for patients undergoing active orthodontic treatment who need to change providers. This form ensures that all relevant medical history and treatment details are accurately conveyed to the new orthodontist.
Accurate completion of the form is crucial. It includes sections for patient information, treatment history, and specific concerns, which help the new provider understand the patient's unique situation.
Patients should be aware that transferring treatment may result in changes to fees and payment policies. It is common for costs to increase, so discussing financial arrangements with both the current and new orthodontist is advisable.
Documentation of treatment progress is vital. The form requires detailed accounts of the treatment plan, appliances used, and patient cooperation, providing the new orthodontist with a comprehensive view of the patient's journey.
Patients or guardians must sign the form to authorize the transfer of records. This signature confirms that the current orthodontist can release the necessary information to the new provider.
It is recommended that patients verify the status of their records. The form includes options to indicate whether records are enclosed, duplicates are available, or if they will be sent separately.

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Documents used along the form

When transferring orthodontic care, several documents are often utilized alongside the AAO Transfer Form. Each of these documents serves a specific purpose in ensuring a smooth transition and continuity of treatment. Below is a list of commonly associated forms and documents, along with brief descriptions of their significance.

Patient Authorization Form: This document grants permission for the current orthodontist to release the patient's records to the new provider. It ensures that the patient’s privacy is respected while facilitating the transfer of essential information.
Financial Agreement: This form outlines the financial obligations associated with the orthodontic treatment. It details payment plans, outstanding balances, and any changes in fees that may occur due to the transfer.
Treatment Summary: A concise overview of the patient’s treatment history, including the procedures completed and any future recommendations. This summary helps the new orthodontist understand the patient's current status and treatment goals.
Medical History Form: This document contains vital information regarding the patient’s medical background, allergies, and any other health concerns that may impact treatment. It is crucial for the new provider to be aware of these details.
Consent for Release of Information: This form authorizes the sharing of sensitive medical and financial information between the previous and new orthodontists. It helps ensure compliance with privacy regulations.
Records Transfer Checklist: A list that outlines all the necessary records to be transferred, such as X-rays, treatment notes, and photographs. This checklist helps both offices ensure that nothing is overlooked during the transfer process.
Insurance Information Form: This document provides details about the patient’s insurance coverage, including policy numbers and benefits. It assists the new provider in verifying coverage and understanding financial responsibilities.
Non-disclosure Agreement Form: This agreement is essential for maintaining confidentiality during the transfer process. It protects sensitive information shared between parties and can be found at https://californiadocsonline.com/non-disclosure-agreement-form.
Patient Feedback Form: A form that allows the patient or guardian to express any concerns or preferences regarding the transfer. This feedback can help the new orthodontist tailor their approach to the patient’s needs.
Follow-Up Appointment Schedule: A proposed timeline for follow-up appointments with the new orthodontist. This schedule helps ensure that treatment continues without unnecessary delays.

Each of these documents plays a vital role in facilitating a seamless transition of care. By ensuring that all necessary information is shared and understood, both the patient and the new orthodontist can work together effectively to achieve the best possible treatment outcomes.

Dos and Don'ts

When filling out the AAO Transfer form, it's important to follow certain guidelines to ensure accuracy and efficiency. Here are five things you should do and five things you shouldn't do:

Do provide complete and accurate patient information, including full names and contact details.
Do clearly outline the treatment history and progress to give the new provider a comprehensive understanding.
Do specify any special health concerns that may affect treatment.
Do check all boxes regarding available records to ensure nothing is overlooked.
Do sign and date the form to validate the request for transfer.

Don't leave any sections blank; incomplete information can delay the transfer process.
Don't use abbreviations or shorthand that may confuse the new provider.
Don't forget to include the patient's current orthodontic status, including any appliances used.
Don't neglect to inform the patient or guardian about potential changes in treatment fees.
Don't submit the form without confirming that all required signatures are present.

Common mistakes

Filling out the AAO Transfer form can be a straightforward process, but many individuals make common mistakes that can lead to complications. One of the most frequent errors occurs in the section requiring the patient's personal information. Incomplete or incorrect entries, such as a missing Social Security number or an incorrect birth date, can cause delays in treatment and affect insurance claims. It’s crucial to double-check all personal details to ensure accuracy.

Another common mistake is neglecting to provide a comprehensive treatment history. This includes significant health concerns and the chronology of treatment rendered. Omitting this information can hinder the new orthodontist's ability to understand the patient’s current condition. When detailing treatment progress, it’s important to include specific dates and descriptions of the appliances used, as this information is vital for continuity of care.

Many individuals also overlook the importance of documenting patient cooperation. This section includes aspects such as oral hygiene practices and the patient’s attitude toward treatment. Inaccurate or vague responses can mislead the new provider about the patient's commitment to their orthodontic care. Providing clear and honest insights can help the new orthodontist tailor their approach effectively.

Furthermore, financial details are often filled out carelessly. Mistakes in recording the total charges before transfer or the unpaid amount can create misunderstandings regarding billing. It’s essential to review these financial figures thoroughly, as discrepancies can lead to disputes between the patient, the transferring office, and the new provider.

Lastly, individuals sometimes forget to sign and date the form. This simple oversight can render the transfer invalid. Ensuring that all required signatures are in place is crucial for the smooth transition of records. Taking the time to carefully review the entire form before submission can prevent these common pitfalls and facilitate a seamless transfer of care.

File Characteristics

Fact Name	Description
Purpose	The AAO Transfer Form is used to facilitate the transfer of orthodontic records from one provider to another during ongoing treatment.
Patient Information	It collects essential patient details, including name, birth date, and contact information, to ensure accurate record transfer.
Health Concerns	The form includes sections for special health or history concerns, allowing new providers to understand the patient's medical background.
Treatment History	Details about the treatment plan and progress are documented, providing continuity in care for the patient.
Financial Information	The form outlines the financial aspects, including fees paid and any outstanding balances, ensuring transparency for the patient.
Record Transfer	It specifies which records are available for transfer, such as x-rays and treatment progress notes, to aid the new orthodontist.
Patient Cooperation	Sections on patient cooperation and suggestions for motivation are included to help the new provider understand the patient's engagement level.
Governing Law	In California, the transfer of medical records is governed by the California Civil Code § 56.10, which ensures patient confidentiality.

Form Sample

AAO TRANSFER FORM

PATIENT IN ACTIVE TREATMENT

Date _______________

To ____________________________________________________

From __________________________________________________

Phone ___________________ Fax __________________ Email: __________________________________________________

Patient's name _______________________________________ Birth date ____________________ Sex _________________

Social Security # __________________________ Phone ___________________

Responsible party __________________________________ Relationship: ____________________

Home address __________________________City _________________ State/Province ____________ Zip code __________

ANALYSIS (Including significant history & TMD) ________________________________________________________________

________________________________________________________________________________________________________

PATIENT/PARENT CONCERNS RE: TX _______________________________________________________________________

SPECIAL HEALTH OR HISTORY CONCERNS ___________________________________________________________________

TREATMENT PLAN (Including chronology of treatment rendered) _________________________________________________

________________________________________________________________________________________________________

TREATMENT PROGRESS (Including chronology of treatment rendered)____________________________________________

________________________________________________________________________________________________________

APPLIANCES

Fixed appliance:

Type_______________ Manufacturer _____________ Type of bracket: metal or non-metal Variations__________

Date bands and/or brackets placed: Max_______ Mand _______ Bonding Agent _______ Cementing Agent _________

Current archwire size and type: Max ______________ Mand _________________

Intraoral elastics: dates initiated, size and direction_____________________ Hours requested______________________

Extraoral appliance:

Type________________ and dates initiated______________________ Hours requested ____________________________

Removable appliance:

Type and dates initiated______________________________ Hours requested _________________________

Clear tray appliance:

Manufacturer _______________ Total trays ______ Trays delivered______ Change interval __________________________

Case/Patient number______________________

PATIENT COOPERATION

Oral hygiene __________________________________________ Headgear _________________________________________

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 ______________________________