Fill Out a Valid Aao Transfer Form

Fill Out a Valid Aao Transfer Form

The AAO Transfer Form is a document designed to facilitate the transfer of orthodontic patient records between providers. It ensures that essential information about the patient's treatment plan, progress, and special considerations are shared seamlessly. The form plays a crucial role when a patient in active orthodontic treatment needs to switch orthodontists, covering everything from patient details and treatment history to future recommendations and financial arrangements.

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In the complex journey of orthodontic treatment, the path sometimes necessitates a pivot—especially when a patient must transition care from one provider to another. This process, while seemingly straightforward, involves a meticulous exchange of detailed patient information to ensure the continuity and efficacy of treatment. The American Association of Orthodontists (AAO) provides a structured protocol for this transition through the AAO Transfer Form. This comprehensive document, designed with precision, encapsulates all facets of the patient’s ongoing treatment: from personal identifiers to the minutiae of the orthodontic appliances in use and the specifics of treatment progress. The form not only serves as a bridge between orthodontic practices but also emphasizes the importance of informed consent and financial clarity, arming the receiving practitioner with all necessary background to make the transition as seamless as possible. It underscores the cooperative spirit required among professionals to prioritize patient care above all, detailing treatment plans, expected outcomes, and patient cooperation levels alongside special health concerns that may influence orthodontic work. Moreover, it highlights the potential financial implications of such a transfer, preparing all parties for adjustments in treatment costs. Thus, the AAO Transfer Form emerges as a crucial tool in managing the continuity of care, representing a well-thought-out process that strives to minimize the impact on the patient's journey towards a healthier, well-aligned smile.

Document Example

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

Form Breakdown

Fact Name Description
Purpose of the Form Used for transferring a patient's orthodontic treatment records when changing orthodontists.
Parts of the Form Includes sections for patient information, treatment details, financial information, and records available for transfer.
Key Information Required Requires detailed patient information such as name, birth date, and social security number, along with treatment and financial details.
Treatment Details Describes the patient’s current treatment plan, progress, appliances used, and patient cooperation.
Financial Information Includes details about the treatment fees, payments made, and the remaining balance.
Record Transfer Authorization Contains a section for the patient or guardian to authorize the transfer of records to a new provider.
Recommendations and Estimates Offers recommendations for continued treatment and retention, along with original and estimated remaining active treatment time.
Records for Transfer Lists types of orthodontic records available for transfer, such as initial and progress casts, x-rays, and intraoral scans.

Aao Transfer - Usage Guide

When it comes to changing orthodontists mid-treatment, the AAO Transfer Form is a critical document that helps ensure a smooth transition. This form allows for the seamless transfer of a patient's orthodontic records, including details about their treatment plan, progress, and any special health history. Completing this form thoroughly and accurately is key to helping the new orthodontist pick up where the previous one left off, potentially avoiding unnecessary delays or complications in the patient's treatment. Here are the steps you need to follow to fill out the AAO Transfer Form effectively.

  1. Start with the Date at the top of the form, entering the current date.
  2. In the "To" section, write the full name and address of the new orthodontic office.
  3. In the "From" section, fill in the contact information of the current orthodontic office, including phone and fax numbers, and email.
  4. Enter the Patient's name, Birth date, Sex, Social Security #, and Phone number in the designated areas.
  5. Fill out the Responsible party field with the name of the person responsible for the patient, their relationship to the patient, and their contact information, including home address, city, state/province, and zip code.
  6. In the sections for Analysis, Patient/Parent concerns, Special Health or History Concerns, Treatment Plan, and Treatment Progress, provide detailed information as requested. These sections are crucial for ensuring the receiving orthodontist understands the patient's history and current treatment status.
  7. Detail any Appliances used, including fixed, extraoral, removable, and clear tray appliances, specifying types, manufacturers, dates initiated, and other relevant information.
  8. Describe the Patient Cooperation level regarding oral hygiene, headgear, elastics, clear trays, attendance at appointments, and attitude toward treatment.
  9. Fill in the Active TX Time Estimates section with details about the original treatment time estimate, remaining time, and percentage of completed treatment.
  10. Under Recommendations for Continued Treatment and Retention, provide any suggestions or necessary steps for the new provider.
  11. Add any Additional Comments that might be helpful for the successful continuation of the patient’s treatment.
  12. Complete the Financial section with details regarding fees, payment terms, third-party payments, and the amounts before transfer.
  13. List the Available Records for Transfer, marking which are initial or progress records and the respective dates.
  14. Sign the form at the bottom, alongside the date, to authorize the transfer. Include the Request to Transfer Records to New Provider section, signed by the patient or guardian, to release the records officially to the new orthodontist.

After filling out the form, review all the details to ensure accuracy. Once completed, the form should be sent to the new provider's office, along with any requested orthodontic records. This proactive step facilitates continuous and effective treatment, ensuring the patient’s orthodontic care needs are met without significant interruptions.

More About Aao Transfer

What is an AAO Transfer Form?

The AAO Transfer Form is a document used within the field of orthodontics to facilitate the transfer of a patient in active treatment from one orthodontist to another. It includes comprehensive details about the patient's treatment plan, progress, and financial information, as well as authorization for the transfer of medical records to ensure continuity of care.

Why is the AAO Transfer Form necessary when changing orthodontists?

Orthodontic treatment is highly individualized, requiring detailed knowledge of the patient's dental history, specific needs, and the course of treatment planned or underway. The AAO Transfer Form provides the new orthodontist with all this crucial information, ensuring a seamless continuation of care without unnecessary delays or setbacks. This form also helps in communicating any financial obligations and the status of the patient's treatment progress.

What information is included in the AAO Transfer Form?

The form contains sections for the patient's personal information, treatment analysis, concerns raised by the patient or parent regarding treatment, special health history, detailed treatment plans and progress, types of appliances used, patient cooperation, and estimated time frames for active treatment. It also covers recommendations for continued treatment, retention, and additional comments on care, alongside a comprehensive financial breakdown and consent for transferring orthodontic records.

How does the transfer process work with this form?

Once a patient decides to change their orthodontist, the current provider fills out the AAO Transfer Form with all the necessary details and obtains consent from the patient or their guardian for the release of their records. This form, along with the patient's orthodontic records, is then sent to the new provider, who reviews the information to understand the patient's treatment plan and history. This process ensures that the new orthodontist is fully prepared to continue the patient's treatment effectively.

Are there any fees associated with transferring orthodontic care?

Yes, there might be fees associated with transferring orthodontic care. These can be related to the duplication and transfer of records, and possibly, variations in treatment fees between the original and new orthodontist. The AAO Transfer Form includes sections outlining any financial arrangements and informs patients that treatment fees can vary widely. It is advisable for patients to discuss these matters with both the current and new orthodontist to understand any additional charges that may apply.

What steps should patients take if they need to use the AAO Transfer Form?

Patients needing to transfer their orthodontic care should first discuss their intention with their current orthodontist. Together, they will complete the AAO Transfer Form, including signing the necessary authorization for the release of orthodontic records. The current orthodontist may also assist in finding a qualified new orthodontist if needed. Patients should ensure they understand any financial obligations and the treatment plan going forward with their new orthodontist.

Common mistakes

Filling out the AAO Transfer Form may seem straightforward, but errors can disrupt the smooth transition of orthodontic care. It's essential for patients and orthodontists to avoid common mistakes that can lead to delays or misunderstandings.

One common mistake is failing to provide a complete and accurate account of the patient's treatment history, including the analysis and significant history. Omitting details about past treatments, TMD (Temporomandibular Disorders) analysis, and special health concerns can misguide the receiving orthodontist, affecting the continuity and quality of care.

Another frequent oversight is neglecting to clearly list the patient or parent's concerns regarding treatment. This section is crucial for understanding the patient's perspective and expectations, ensuring that these are communicated and addressed by the new provider.

Incorrectly or incompletely filled details regarding the treatment plan, including appliances used, dates initiated, and manufacturers, can cause confusion. For the receiving orthodontist, understanding precisely what has been done and what needs to be continued or adjusted is vital for a seamless transition.

Sometimes, the section on patient cooperation is overlooked. However, noting the patient's oral hygiene, use of prescribed appliances like headgear or elastics, and their overall attitude towards treatment gives the new orthodontist valuable insight into potential challenges or areas needing focus.

Leaving the financial section vague or incomplete is a significant misstep. Both transferring and receiving parties need a clear understanding of the financial arrangements, including any unpaid portion or discrepancies in the treatment fees, to prevent disputes or misunderstandings about payment responsibilities.

Not correctly indicating the status of available records for transfer or failing to ensure their prompt and proper delivery can hinder the new orthodontist's ability to continue treatment effectively. Whether records are enclosed, sent under separate cover, or duplicates are sent upon request should be clearly marked, and any charges conveyed to the patient.

Forgetting to sign and date the form is a minor yet critical error. The signature serves as a formal authorization for the transfer of records and continuity of care, making it legally binding. It’s a simple step that carries significant legal and procedural weight.

Additionally, inaccuracies in patient information, such as the birth date, Social Security number, or contact information, can lead to administrative hurdles. Precision in filling these fields ensures that records are correctly matched and communicated between offices.

Lastly, overlooking the advice section that outlines recommendations for continued treatment and retention can lead to a disruption in the treatment plan. Clearly stating these recommendations ensures that the new orthodontist is aware of any specific considerations or preferences that may impact the patient's treatment outcome.

Documents used along the form

When handling an AAO Transfer form, it's crucial to understand that seamless coordination between healthcare providers can significantly enhance the patient's experience and treatment outcome. To support this form, several additional documents are often used. Each plays a pivotal role in ensuring the transfer process is as comprehensive and smooth as possible.

  • Patient Consent Form: This document is paramount as it records the patient's or guardian's consent for transferring their medical records to a new healthcare provider. It ensures that both parties are aware of and agree upon the transfer of sensitive information.
  • Medical History Form: A detailed form that encapsulates the patient's medical history, including past treatments, allergies, medications, and any pertinent family medical history. Sharing this information is essential for the receiving orthodontist to tailor the treatment plan effectively.
  • Treatment Plan Overview: A summary or detailed description of the planned or ongoing treatment, including goals, strategies, and anticipated outcomes. It provides the receiving orthodontist a clear roadmap of the intended orthodontic objectives and procedures.
  • Financial Agreement/Statement: This document outlines the financial arrangements made with the previous provider, including payment plans, balances, and any other agreements related to the cost of treatment. It's useful for establishing transparency and continuity in financial matters with the new provider.

Together, these documents form a comprehensive transfer package, ensuring the new orthodontic provider has all necessary information to continue the patient's care effectively. This thoughtful compilation facilitates a smoother transition, mitigates the risk of treatment interruptions, and fosters an environment of trust and continuity for the patient.

Similar forms

The AAO Transfer Form is closely related to the Medical Records Release Form. Both serve the key purpose of transferring vital information from one professional to another to ensure continuity of care. While the AAO Transfer Form specifically addresses the transfer of orthodontic records and treatment details, a Medical Records Release Form covers a broader range of medical history, including diagnostics, treatment plans, and other healthcare-related information. Both forms require patient authorization to transfer these sensitive documents, ensuring patient privacy and compliance with healthcare regulations.

Another similar document is the HIPAA Authorization Form. This form is used in the healthcare sector to authorize the release of an individual's health information in accordance with the Health Insurance Portability and Accountability Act (HIPAA). Like the AAO Transfer Form, it protects patient privacy while allowing necessary health information to be shared with relevant parties. Both documents play crucial roles in facilitating effective communication between healthcare providers and ensuring that patient care is not compromised during transitions.

The Dental Records Transfer Form shares similarities with the AAO Transfer Form, focusing on the dental sector. It involves the transfer of dental history, including procedures, treatments, and notes, from one dentist to another. The primary goal is to provide the receiving dentist with comprehensive background information necessary for ongoing patient care, similar to how the AAO Transfer Form equips the receiving orthodontist with essential treatment details and plans for patients undergoing orthodontic treatment.

The Treatment Plan Transfer Form, although not as widely recognized, also parallels the AAO Transfer Form. It is specifically designed to communicate detailed treatment strategies, including past procedures and future treatment plans, between healthcare providers. While it can apply across various medical disciplines, its role in ensuring that the new provider is fully informed about the patient's current treatment status and future needs is akin to the objectives of the AAO Transfer Form in the orthodontic specialty.

Consent to Treat Forms, commonly used across different areas of healthcare, are also related to the AAO Transfer Form in a fundamental way. These forms are typically used to obtain a patient's agreement for receiving treatment from a healthcare provider. Although the primary intent differs, both forms ensure that the patient is informed and agrees to the ensuing steps in their healthcare journey, whether it's a specific treatment or transferring their records to continue treatment with a new provider.

Lastly, the Referral Form used by healthcare providers when a patient needs to see a specialist shares a similar aim with the AAO Transfer Form. It includes critical patient information and the reason for referral, ensuring the specialist is well-informed before the first visit. Like the AAO Transfer Form, it facilitates a smooth transition and continuity of care by sharing important details about the patient's condition and treatment needs with the new provider.

Dos and Don'ts

When filling out the AAO Transfer form, it's important to follow these guidelines to ensure the process is smooth and error-free. Here is a list of things you should and shouldn't do:

Do:
  • Ensure all information is accurate and complete, including the date, patient's personal information, and treatment details.
  • Clearly state both the transferring and receiving orthodontists’ contact information, including phone numbers and email addresses.
  • Include a comprehensive analysis, mentioning any significant history and TMD (temporomandibular disorders) concerns.
  • List the patient's or parent's concerns regarding treatment to ensure they are addressed by the new provider.
  • Provide a detailed treatment plan, including the chronology of treatment rendered thus far.
  • Update the treatment progress section accurately to reflect the current status of treatment.
  • Indicate the type of appliances used, including fixed, extraoral, and removable appliances, ensuring to note the manufacturer and type where applicable.
  • Detail the patient’s cooperation level in different aspects like oral hygiene, use of elastics, and attendance of appointments, which is crucial for the receiving orthodontist to know.
  • Make a clear statement about the financial aspects of the treatment, including fees and payment terms up until the transfer.
  • Sign the form and include the date to officiate the request for transferring records.
Don't:
  • Leave any fields blank. If something is not applicable, mark it as such with "N/A" or "None."
  • Forget to specify whether records will be sent with the form, separately, or are available upon request.
  • Omit special health or history concerns that could influence ongoing or future treatment plans.
  • Assume the receiving orthodontist has access to previous records without explicit confirmation they have been transferred or are available upon request.
  • Exclude details regarding clear tray appliances, such as the manufacturer, total trays, and trays delivered, if applicable.
  • Fail to include active treatment time estimates, which help the new provider to gauge the level of progress and remaining work.
  • Omit recommendations for continued treatment and retention strategies to ensure continuity of care.
  • Ignore the section on patient cooperation, as this information is vital for the new orthodontist to understand the patient's compliance with treatment.
  • Forget to detail the financial status, including any unpaid amount still owed to the transferring office, as this ensures transparency and prevents future disputes.
  • Submit the form without ensuring all necessary signatures are in place, including those of the patient or guardian authorizing the release of records.

Misconceptions

When discussing the American Association of Orthodontists (AAO) Transfer Form, several misconceptions often arise. Addressing these can help clarify the purpose and process of orthodontic transfer.

  • Misconception 1: The AAO Transfer Form is only for transferring patients' basic information.

    This form goes beyond basic information, facilitating the comprehensive transfer of a patient's orthodontic records, including treatment history, analysis, concerns, and special health history.

  • Misconception 2: Any orthodontist can complete the treatment once the transfer form is filled out.

    It's critical that the receiving orthodontist is fully informed and agrees to continue the treatment as planned or adjusts according to their professional judgment.

  • Misconception 3: The AAO Transfer Form negates the need for a new patient consultation at the new orthodontist.

    Even with the transfer form, a comprehensive new patient consultation is often necessary for the receiving orthodontist to understand the patient's needs fully.

  • Misconception 4: Patient's financial obligations are fully transferred with the AAO Transfer Form.

    While the form includes information about financial arrangements, negotiations with the new office regarding fees and payments might still be needed.

  • Misconception 5: The form is only used for transferring within the same country.

    The form is designed to facilitate transfers both domestically and internationally, acknowledging that treatment standards and costs can significantly vary.

  • Misconception 6: Digital records cannot be transferred using the AAO Transfer Form.

    The form accommodates the transfer of both physical and digital orthodontic records, including scans and digital images.

  • Misconception 7: All orthodontic offices accept transferred patients.

    Acceptance of a transferred patient depends on the new orthodontist's capacity, agreement with the proposed treatment plan, and other factors.

  • Misconception 8: The transfer process is instantaneous.

    Transferring patients' records and ensuring the new orthodontist is fully briefed takes time. Both parties should allow for a transitional period.

  • Misconception 9: The original treatment plans must remain unchanged after the transfer.

    The new orthodontist must evaluate the treatment plan and may suggest modifications based on their professional judgment and the patient's current condition.

  • Misconception 10: Transferred patients’ treatment costs are always the same or lower.

    The form explicitly indicates that treatment fees can vary and may increase after the transfer, depending on several factors, including geographical location and treatment complexity.

Addressing these misconceptions is essential for patients and orthodontic professionals to ensure a smooth and informed transfer process. It underscores the importance of clear communication, understanding each party's responsibilities, and setting appropriate expectations for transferred orthodontic care.

Key takeaways

Filling out and using the AAO Transfer Form is crucial for the seamless transition of a patient's orthodontic treatment from one provider to another. This process ensures that all relevant patient information, treatment details, and financial arrangements are clearly communicated. Here are the key takeaways:

  • The form begins by capturing basic information including the patient's name, birth date, sex, social security number, and the responsible party’s contact details. This ensures the new orthodontist has all necessary patient identifiers.
  • It includes sections for detailed analysis, including any significant history and concerns related to temporomandibular disorders (TMD), providing the new orthodontist with background on the patient's orthodontic issues.
  • Patient or parent concerns regarding treatment are directly addressed, ensuring that the new provider is aware of any specific expectations or anxieties the patient has about their orthodontic care.
  • The form outlines the patient's treatment plan, including the chronology of treatment rendered so far, which aids the receiving orthodontist in understanding what has been done and what needs to be continued or adjusted.
  • Details about the treatment progress, including types and dates of appliance placements, are crucial for understanding the current status and for planning future steps effectively.
  • Patient cooperation, including oral hygiene and adherence to prescribed treatments like headgear or elastics, is noted, providing insight into potential challenges or areas for motivation.
  • It prepares the patient or the responsible party for potential increases in treatment costs upon transfer, providing a transparent overview of financial aspects related to the continuation of care.
  • The form facilitates the transfer of essential records, including casts, x-rays, and photographs, ensuring the receiving orthodontist has all necessary documentation to continue treatment effectively.

By meticulously filling out and transferring this form, a strong foundation is laid for the successful continuation of orthodontic treatment, ensuring patient concerns are addressed, and facilitating a smooth transition between orthodontic providers.

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