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Free Aao Transfer PDF Template

The AAO Transfer Form is an essential document designed specifically for the process of transferring a patient undergoing active orthodontic treatment from one orthodontist to another. It meticulously records all necessary details such as the patient's information, treatment plan, progress, and financial standing to ensure a seamless continuation of care. By filling out this form, both the current and the receiving orthodontists are well-informed of the patient's orthodontic condition, goals, treatment history, and any financial commitments, facilitating a smooth transition in the course of the treatment.

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Outline

Managing an orthodontic transfer during active treatment involves several critical steps to ensure a seamless continuation of care. The AAO Transfer Form plays a pivotal role in this process, acting as a comprehensive tool that facilitates the smooth transition of a patient from one orthodontic provider to another. It encompasses a wide array of information, including patient details such as name, birth date, and contact information, alongside specified treatment data — analysis, patient or parent concerns, special health history, treatment plan progress, and details regarding appliances used. Furthermore, it addresses patient cooperation, estimated active treatment time, and recommendations for ongoing treatment and retention. Financial considerations and records transfer are also integral components of the form, ensuring that the receiving office has a full understanding of the patient's treatment history, financial standing, and the status of available records for transfer. Equally important is the authorization section, where patients or their guardians consent to the release and transfer of records to the new provider, underscoring the importance of mutual understanding and agreement in the transfer process. This document, endorsed by the American Association of Orthodontists, ensures that transitions can occur smoothly, with minimal disruption to the patient's treatment plan.

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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 _________________________________________

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 ______________________________

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Document Attributes

Fact	Detail
Form Purpose	Facilitates the transfer of orthodontic records for patients in active treatment between providers.
Content Required	Includes patient information, treatment analysis, treatment progress, appliances used, patient cooperation level, estimated treatment times, and recommendations.
Financial Information	Details financial arrangements such as fees, payments, and outstanding amounts for transparency and continuity of financial arrangements post-transfer.
Original Provider Responsibility	The form outlines the responsibility of the original provider to find a qualified orthodontist for the patient's continued treatment.
Records Transfer	Specifies the types of records available for transfer and condition for duplication, if requested, might incur an additional charge.
Patient or Guardian Authorization	Includes a section for authorization by the patient or guardian for the release and transfer of records to the new provider.
Treatment Costs Warning	Advises that treatment costs may vary and likely increase after the transfer due to differences in treatment fees and payment policies across locations.
Governing Law	While the form is standardized by the American Association of Orthodontists, the actual transfer and handling of medical records are subject to state-specific privacy and health care laws.

How to Fill Out Aao Transfer

When a patient undergoes orthodontic treatment, situations may arise necessitating a change in their care provider. This could be due to relocation, the need for a specialist, or other personal reasons. The AAO Transfer Form ensures a smooth transition by providing the new orthodontist with detailed insights about the patient's orthodontic journey, including analysis, treatment plans, and progress, as well as special health notes and any concerns raised by the patient or parent. This organized handover is crucial for the continuation of care, ensuring that the new orthodontist has all necessary background information to proceed confidently with the treatment.

Steps to Fill Out the AAO Transfer Form

Enter the date at the top of the form.
Fill in the receiving orthodontist’s contact information where indicated: "To" section.
Provide the transferring orthodontist’s contact information in the "From" section, including phone and fax numbers, as well as email.
Enter the patient's full name and contact information, including their birth date, sex, social security number, and phone number.
Document the name of the responsible party for the patient, their relationship to the patient, and their home address, including city, state/province, and zip code.
In the "Analysis" section, detail any significant history and diagnoses, including temporomandibular disorder (TMD) if applicable.
List patient or parent concerns regarding treatment in the designated area.
Provide information on any special health or history concerns relevant to the patient’s orthodontic treatment.
Outline the treatment plan, including a chronology of treatment rendered, under "TREATMENT PLAN".
Describe the treatment progress, also in a chronological format.
Under "APPLIANCES", specify any fixed, extraoral, removable, and clear tray appliances used, including types, manufacturers, dates initiated, and hours requested.
Assess the patient's cooperation in various aspects such as oral hygiene, appliance care, and general attitude towards treatment.
Estimate the percentage of active treatment completed and any original and remaining treatment times.
Provide recommendations for continued treatment and retention strategies.
Add any additional comments regarding the patient’s treatment, including financial details such as fees and payment terms.
If applicable, check off which types of orthodontic records are available for transfer and mark the relevant status concerning the sending of these records.
Complete the form with the transferring orthodontist’s signature and date.
On the last page, the patient or guardian must authorize the release and transfer of records by filling the blanks with their details, the new provider’s name, and signing at the bottom.

Note that ensuring this form is filled out comprehensively and accurately is key to a seamless transition for the patient, allowing continuous and effective orthodontic care. Both the transferring and receiving orthodontists, as well as the patient, play vital roles in this process.

More About Aao Transfer

What is an AAO Transfer Form used for?

The AAO Transfer Form is essential for facilitating a smooth transition when a patient in active orthodontic treatment needs to change their orthodontist, whether due to relocation or other personal reasons. It ensures that all pertinent information, including the patient's treatment plan, treatment progress, special health history, and financial information, is shared with the new provider. This comprehensive exchange of information aids the new orthodontist in understanding the patient's orthodontic conditions, goals, and the specifics of their ongoing treatment, thereby maintaining the continuity and effectiveness of care.
How does the AAO Transfer Form benefit the patient during the transfer process?

By using the AAO Transfer Form, patients benefit in several critical ways. It streamlines the process of transferring all necessary orthodontic records and information, minimizing disruptions in their treatment plan. It also ensures that the new orthodontist receives a detailed history of the patient's treatment to date, including any appliances used, treatment progress, and financial details. This comprehensive transfer of records is designed to ensure that the new orthodontist can seamlessly continue the patient's care without unnecessary delays or repeat diagnostics. Additionally, it helps patients understand that treatment fees and payment policies may vary, setting transparent expectations for the continuation of care.
What types of records can be transferred with the AAO Transfer Form?

The AAO Transfer Form allows for the transfer of a wide range of orthodontic records crucial for continuing patient care. These include casts, cephalometric x-rays, panoramic x-rays, CBCT images, intra-oral scans, intraoral and facial photographs, and any progress records. All these records can provide a complete picture of the patient's orthodontic status and treatment progress. The form also indicates whether duplicates of records are sent upon request, are enclosed with the form, or sent under separate cover, ensuring that the new provider has access to all necessary documentation.
What should a patient do if they are planning to transfer to a new orthodontist?

If a patient plans to change their orthodontist, the first step is to communicate this decision to their current orthodontist and fill out the AAO Transfer Form. It is important for the patient or guardian to authorize the release of all orthodontic records for the continuation of treatment by signing the form. Patients should discuss any concerns regarding the transfer process, treatment expectations, and financial implications with their current orthodontist. This proactive communication will ensure a smoother transition and help the new orthodontist pick up where the previous treatment left off without any hitches.
Are there any financial considerations to be aware of when transferring orthodontic care?

Yes, financial considerations are an integral part of the AAO Transfer Form and the transfer process. The form provides detailed information on the financial status of the patient's treatment, including fees for active treatment, any extras, terms of payment, third-party payments, total charges before transfer, the amount paid before transfer, and the unpaid amount still owed to the transferring office. It also alerts patients to the possibility that orthodontic treatment fees can vary significantly in different locations. As a result, patients are advised to expect that transferring their care may lead to an increase in total treatment costs and possibly changes in payment policies. These disclosures are meant to ensure that patients are fully informed and can plan accordingly for the financial aspects of continuing their treatment with a new provider.

Common mistakes

When filling out the AAO Transfer Form, attention to detail is crucial for ensuring that the transfer of a patient's orthodontic care proceeds smoothly. However, common mistakes can occur, potentially complicating the process. Here is a list of seven mistakes frequently made:

Omitting important dates such as when the initial and progress records were taken. These dates are crucial for the new provider to understand the timeline of treatment.
Not clearly stating the patient's concerns regarding treatment, which helps the new orthodontist prioritize and address these issues promptly.
Failing to include a detailed treatment plan and treatment progress report. This information provides the new orthodontist with a roadmap of what has been done and what needs to be completed.
Incorrectly documenting the types and details of appliances used. This includes fixed appliances, extraoral appliances, removable appliances, and clear tray appliances. Each detail, from the type of bracket to the manufacturer, plays a role in the continuity of care.
Overlooking the patient’s cooperation section, which includes oral hygiene, headgear, elastics, clear trays, appointments, broken appliances, and the patient's attitude toward treatment. This assessment is vital for the new provider to understand any challenges that may lie ahead.
Neglecting to provide a thorough analysis that includes significant history and any TMJ (temporomandibular joint) concerns. This oversight can lead to missed nuances in treatment planning.
Not completing the financial information section accurately or completely, including details about fees, terms, third-party payments, and the balance owed. This is necessary to ensure a smooth financial transition alongside the clinical transfer.

In addition to these common mistakes, ensuring that all sections related to records transfer are filled out correctly is important. This includes:

Indicating whether casts, Ceph, panoramic, CBCT, intra-oral scans, intraoral x-rays, facial photos, and intraoral photos are available for transfer.
Specifying the status of these records (sent, enclosed, or sent under separate cover).
Completing the request to transfer records to a new provider section, including all necessary signatures and dates.

Adhering to these guidelines helps facilitate a seamless transition for patients undergoing orthodontic treatment, ensuring no detail is overlooked.

Documents used along the form

When transferring orthodontic care to a new provider, the AAO Transfer Form plays a crucial role in ensuring that all relevant patient information, ongoing treatment details, and records are smoothly transitioned. Alongside this essential document, there are several other forms and documents that often accompany it to make the process comprehensive and streamlined. Understanding the significance and purpose of each document can greatly facilitate both the patient's and the receiving orthodontist's preparations for continuing care.

Medical History Form: This document provides a detailed account of the patient's overall health, previous medical conditions, allergies, medications, and any relevant family medical history. It's vital for the new orthodontist to be aware of these factors to ensure safe and effective orthodontic treatment.
Consent For Treatment Form: This form is an agreement signed by the patient or the patient's guardian, granting permission to the new orthodontic office to proceed with treatment. It typically outlines the nature of the treatment, potential risks, benefits, and alternatives.
Insurance Information Form: To facilitate billing and ensure that the patient receives the benefits they are entitled to, this document collects detailed insurance policy information. It includes the insurance company name, policy holder's information, and coverage details.
Privacy Policy Acknowledgement Form: This form is an acknowledgement from the patient or guardian that they have received and understand the new practice's privacy policies, especially in relation to the Health Insurance Portability and Accountability Act (HIPAA). It ensures patients are aware of their rights regarding their personal and health information.

Each of these documents plays a unique and essential role in the transfer process, ensuring that the new orthodontic provider has all the necessary information to continue treatment safely and effectively. By thoroughly completing and providing these forms alongside the AAO Transfer Form, patients and their families can help ensure a smooth transition to their new orthodontic care provider.

Similar forms

The Medical Information Release Form (HIPAA Release Form) is quite similar to the AAO Transfer Form in terms of function. Both facilitate the secure transfer of sensitive patient information, ensuring that medical or dental history and treatment details are properly communicated between healthcare professionals. The major difference lies in the scope, with the HIPAA Release Form covering a broader array of medical information and being applicable in general healthcare settings beyond orthodontics.
A Dental Patient Referral Form shares commonalities with the AAO Transfer Form by providing detailed patient information, including treatment history and specific needs, to another dental professional. Both forms are pivotal in ensuring continuity of care, yet the referral form is typically used for recommending specialized services or consulting, not necessarily indicating a complete transfer of care responsibility.
The Patient Registration Form is used to gather comprehensive personal and health information from new patients at a healthcare facility. Like the AAO Transfer Form, it collects essential demographic and health-related information. The key distinction is that the registration form is used for intake purposes at a new facility or office, not for the continuation of ongoing treatment following a transfer.
The Treatment Consent Form and the AAO Transfer Form serve to ensure that patients are fully informed and agree to the proposed medical or dental procedures. While the Treatment Consent Form specifically captures the patient’s agreement to the planned course of action for treatment, the AAO Transfer Form encompasses consent for transferring vital treatment information to ensure seamless care continuation.
A Medical Records Request Form is designed to formally request a patient's medical records from one healthcare provider to another. It shares similarities with the AAO Transfer Form by focusing on the transition of critical healthcare information. However, the request form is more general in nature, could be initiated by the patient or the receiving office, and is not specific to the field of orthodontics or the motivations for the transfer.
The Health Insurance Claim Form is similar in the aspect that it also contains detailed personal and treatment information to process insurance claims. Both documents ensure accurate record-keeping and communication between healthcare providers and insurance companies. Unlike the AAO Transfer Form, which is used between orthodontic professionals, the insurance claim form is mainly for administrative purposes to secure payment for services rendered.
A Patient Treatment Plan Form mirrors the AAO Transfer Form’s features with its provision of comprehensive treatment details, including objectives, progress, and expected outcomes. Both are instrumental in laying out the course of treatment. Whereas the Treatment Plan Form is generally an internal document to guide patient care within a single practice, the AAO Transfer Form is specifically geared towards ensuring informed, continuous care when a patient changes orthodontic providers.

Dos and Don'ts

When you are tasked with filling out the AAO Transfer form, it's important to handle the document with care to ensure a smooth transition of orthodontic treatment for the patient. To guide you through this process, here are nine crucial do's and don'ts:

Do ensure that all the information provided on the form is accurate and complete. Double-check the patient's name, birth date, and social security number for correctness.
Don't rush through filling out the form. Taking your time to carefully complete each section can prevent errors and misunderstandings.
Do use clear and legible handwriting if the form is filled out by hand. If possible, filling out the form electronically is recommended to improve readability.
Don't leave any sections blank unless they are not applicable to the patient's case. If a section is not applicable, make sure to write "N/A" to indicate this.
Do include detailed and specific information in the sections for analysis, treatment plan, and treatment progress. The more thorough you are, the easier it will be for the new provider to understand the patient's orthodontic history.
Don't forget to check the appropriate boxes for the types of appliances used, and provide all the relevant details such as the manufacturer, type, and dates initiated.
Do make sure to obtain and document the necessary signatures from the responsible party and the orthodontist to authorize the transfer of records.
Don't overlook the financial section. Clearly state any unpaid amounts still owed to the transferring office, as well as any fees that are open-ended or have not yet been charged.
Do ensure that the available records for transfer are accurately marked and that you specify whether records will be sent under separate cover or enclosed with the form.

By following these do's and don'ts, you will help facilitate a smoother transition for the patient to their new orthodontic provider and ensure that all necessary information is transferred effectively and efficiently.

Misconceptions

When it comes to transferring orthodontic records, there are several misconceptions that need to be addressed. Understanding the AAO Transfer Form is key to ensuring the process is handled effectively and efficiently. Here are six common misconceptions and the truths behind them:

Misconception 1: The AAO Transfer Form is only for transferring records within the same state or country.
In fact, the AAO Transfer Form is designed to facilitate the transfer of orthodontic records regardless of the location, whether it’s within the same state, across states, or even internationally. The goal is to ensure the continuity of care for the patient, wherever they choose to receive treatment.
Misconception 2: Patients need to understand all the medical terminologies on the form.
While it's beneficial for patients to be informed, they do not need to comprehend every medical term used on the form. Orthodontic staff and the receiving orthodontist can help explain the details and significance of the information being transferred.
Misconception 3: Only the transferring orthodontist needs to sign the AAO Transfer Form.
Both the patient (or guardian) and the transferring orthodontist are required to sign the form. The patient's or guardian's signature authorizes the release of records, and the orthodontist’s signature confirms the accuracy of the information and adherence to the agreement.
Misconception 4: Transferring records automatically means higher treatment costs.
While the AAO Transfer Form does caution that fees may vary and could increase after transferring, it is not a given that costs will always rise. Many factors influence treatment costs, and transferring records can sometimes lead to more efficient or cost-effective treatment options.
Misconception 5: The form is only for the transfer of physical records.
The AAO Transfer Form encompasses the transfer of all types of records, including digital records such as intra-oral scans and digital X-rays. It ensures that any comprehensive orthodontic records can be moved to assist in the continuity of care.
Misconception 6: Once the form is signed, the transferring process is immediate.
Although signing the form is a crucial step, the actual transfer of records can take some time. Coordination between offices is required, and occasionally, the creation of duplicate records or arranging for digital transfers may lead to delays.

Clearing up these misconceptions is vital for patients and their families to feel confident and informed throughout the process of transferring orthodontic care. Understanding the purpose and process of the AAO Transfer Form helps ensure a smooth transition to a new provider, ultimately contributing to the successful completion of orthodontic treatment.

Key takeaways

When transferring a patient in active orthodontic treatment from one care provider to another, the AAO Transfer Form plays a crucial role. Here are seven key takeaways about filling out and using this form:

Complete patient information is required: It's essential to include detailed patient information such as name, birth date, sex, social security number, phone number, and the responsible party's details. This information ensures that the receiving orthodontist has all necessary data to continue treatment seamlessly.
Clear documentation of the treatment plan and progress: The form requires a comprehensive outline of the treatment plan, including any significant history and specific details about the appliances used, such as type, manufacturer, and pertinent dates. Documenting treatment progress to date allows the new provider to understand exactly where the patient is in their treatment journey.
Patient cooperation is assessed: Information about the patient's cooperation, including oral hygiene, appliance care, attitude towards treatment, and appointment attendance, offers valuable insight for the new orthodontist to continue effective treatment and motivation strategies.
Financial information must be transparent: The form includes sections for detailing the financial aspects of the patient's treatment, including fees for active treatment, extra charges, terms, and any third-party payments. This transparency helps manage expectations and facilitates discussions about any cost differences post-transfer.
Consent for transferring records is necessary: For a successful transfer of care, the patient or guardian must authorize the release of all orthodontic records to the new provider. This ensures all parties have agreed to the transfer and that the new orthodontist has access to necessary documentation.
Availability of records for transfer: Listing available records for transfer, including casts, cephalometric and panoramic images, intraoral scans, and x-rays, is crucial. This information aids the receiving orthodontist in evaluating the patient's condition and planning ongoing treatment without unnecessary repetition of diagnostic procedures.
Treatment fees may vary widely: The form advises patients that orthodontic treatment fees can vary significantly across different regions. It's important for patients to understand that transferring treatment could result in increased costs and different payment policies, helping to manage their financial expectations.

Overall, the AAO Transfer Form is an essential tool in ensuring a smooth transition for patients undergoing orthodontic treatment when changing care providers. By providing comprehensive information about the patient's treatment, cooperation, and financial details, both orthodontists can ensure the continuation of care is as seamless as possible.

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