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When patients undergo orthodontic treatment, situations may arise necessitating a transfer to another orthodontic specialist. This could be due to a variety of reasons such as moving to a new city or the need for specialized care that another orthodontist can provide. To ensure a smooth transition and continuity of care, the AAO Transfer Form plays a critical role. This comprehensive form facilitates the transfer of detailed patient information between orthodontists, including treatment history, special health concerns, treatment plans, and progress reports. Furthermore, it covers patient cooperation, active treatment time estimates, recommendations for continued treatment, and financial information. The form also outlines the specifics of both fixed and removable appliances used, patient and parent concerns, and any special health or history concerns that may impact treatment. By completing the transfer process, which includes the authorization to release all relevant records for the purpose of continuing treatment, patients are assured that their new provider will have all the necessary knowledge to successfully carry on with their orthodontic care. Additionally, the form signals to patients the potential for increased treatment costs and changes in payment policies, ensuring transparent communication. Therefore, the AAO Transfer Form serves as an essential tool in maintaining high standards of orthodontic care during the transition between specialists.

Form Preview 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

File Characteristics

Fact Name Description
Purpose of the Form This form is used to facilitate the transfer of a patient in active orthodontic treatment from one care provider to another, ensuring continuity of care.
Components of the Form It includes sections for patient information, treatment analysis, treatment plan, progress, and recommendations, as well as financial information and records available for transfer.
Financial Information Disclosure Patient or guardian is informed that orthodontic treatment fees can vary and transferring treatment may result in increased costs.
Governing Law Though not explicitly mentioned, such forms are generally subject to state-specific laws regarding medical records transfer and patient privacy, including HIPAA regulations in the United States.

Steps to Writing Aao Transfer

Filling out the AAO Transfer form is a critical step in ensuring a smooth transition between orthodontists, especially during active treatment. This process not only ensures that the new orthodontist receives all necessary information about the patient's treatment plan, progress, and concerns but also aids in maintaining continuity of care. It’s important to ensure each section of the form is completed accurately to avoid any miscommunication or delays in treatment. Below are the steps to fill out this form effectively.

  1. Enter the date at the top of the form.
  2. Fill in the To section with the name and contact information of the new orthodontist or dental office the records are being transferred to.
  3. Complete the From section with the name and contact information of the current orthodontist or dental office transferring the records.
  4. Provide the patient's name, birth date, sex, social security number, and contact phone number in the designated areas.
  5. Detail the name and relationship of the responsible party, if different from the patient, along with their contact information and home address.
  6. Describe the analysis, including significant history and any Temporomandibular Joint Disorder (TMD) considerations.
  7. List any patient/parent concerns regarding treatment and any special health or history concerns.
  8. Outline the treatment plan, including a chronology of treatment rendered, and detail the treatment progress in a similar format.
  9. Specify details about appliances used, including types, manufacturers, dates placed, and any relevant adjustments or settings.
  10. Assess patient cooperation, including oral hygiene, use of headgear, elastics, clear trays, appointments, and attitude toward treatment.
  11. Provide active treatment time estimates, listing the original estimate alongside the remaining percentage of treatment completed.
  12. Include recommendations for continued treatment and for retention.
  13. Add any additional comments that might be helpful to the receiving orthodontist.
  14. Fill out the financial section, detailing any closed or open-end fees, third-party payments, and the total amount paid or owed before transfer.
  15. Check off any available records for transfer, indicating whether casts, cephalometric x-rays, panoramic x-rays, CBCT scans, intraoral scans, x-rays, facial and intraoral photos are available for transferring and their respective statuses.
  16. Sign and date the form at the bottom as the orthodontist transferring the records.
  17. On the last page, the patient or guardian must authorize the release of records by filling in the orthodontists’ names, signing, and dating the form.

After completing these steps, the form and accompanying records should be sent to the new provider as specified. This clear transfer of information facilitates the continuation of care and helps the receiving orthodontist understand the patient's orthodontic journey, thus ensuring a seamless transition and continuity in the orthodontic treatment.

Important Details about Aao Transfer

What is an AAO Transfer Form?

The AAO Transfer Form is a document used by orthodontists to facilitate the transition of a patient's care from one orthodontic practice to another. It includes detailed information about the patient’s treatment to date, their treatment plan, progress, and any special considerations or health concerns. This form ensures a seamless continuation of orthodontic treatment when a patient needs to change orthodontists due to relocation or other reasons.

When is an AAO Transfer Form necessary?

An AAO Transfer Form is necessary whenever a patient under active orthodontic treatment needs to move to a new orthodontist. This situation could arise from a patient moving to a new area, dissatisfaction with current care, or the need for specialized treatment not available at the existing practice. Completing this form ensures the new orthodontist receives comprehensive information to continue the treatment effectively.

What information is included in the AAO Transfer Form?

The form contains detailed information about the patient, including name, birth date, sex, social security number, and contact details. It outlines the patient’s treatment history, analysis, concerns, special health history, treatment plan, progress, appliances used, patient cooperation, and recommendations for continued treatment and retention. Additionally, it documents financial information and a section for transferring orthodontic records to the new provider.

How does the AAO Transfer Form benefit the patient?

This form benefits the patient by providing a comprehensive summary of their orthodontic treatment so far, facilitating a smooth transition to a new orthodontist. It ensures the new provider has all necessary background information to continue treatment effectively, minimizing repetition of procedures and enabling a seamless continuation of care.

Who completes the AAO Transfer Form?

The current orthodontist treating the patient typically completes the AAO Transfer Form. It is then sent to the new orthodontist, either directly by the current orthodontist or by the patient. The form might also require input or approval from the patient or their guardian, especially regarding the consent to transfer records.

Is patient consent needed to transfer orthodontic records?

Yes, patient consent is crucial for the transfer of orthodontic records. The AAO Transfer Form includes a section for the patient or the patient's guardian to authorize the release of records to the new provider. This consent ensures compliance with privacy laws and regulations governing patient information.

Can an AAO Transfer Form result in additional costs to the patient?

Possibly. The form explicitly states that orthodontic treatment fees can vary significantly, and transferring to a new practice might result in an increase in total treatment costs. This difference could arise from various factors, such as differences in pricing, treatment plans, or unforeseen complications that require additional treatment.

How are orthodontic records transferred?

Orthodontic records can be transferred in several ways, as indicated on the form: directly enclosed with the AAO Transfer Form, sent under separate cover, or duplicated upon request, potentially with an additional charge. The method of transfer will depend on the preferences of the sending and receiving orthodontists and any applicable laws or regulations.

What if the new orthodontist recommends a different treatment plan?

It's common for different orthodontists to have varied approaches to treatment. Upon reviewing the transferred records and conducting an initial examination, the new orthodontist might suggest modifications to the existing treatment plan. These changes are typically discussed in depth with the patient or their guardian to ensure the best possible outcome.

Does the AAO Transfer Form guarantee that a new orthodontist will accept the patient?

No, completing an AAO Transfer Form does not automatically guarantee that the patient will be accepted for treatment by a new orthodontist. However, it provides essential information that can help the new provider make an informed decision. The patient may need to consult with several orthodontists before finding the right match for their needs and treatment goals.

Common mistakes

When filling out the AAO Transfer Form, there are common mistakes that can complicate the process of transferring a patient's orthodontic care. These errors can delay treatment and impact billing or the continuity of care. Understanding these pitfalls can help in ensuring a smoother transfer process.

One common mistake is not providing complete contact information for both the transferring and receiving orthodontic offices. This includes failing to list all necessary phone numbers, fax numbers, and email addresses. When any of this crucial information is missing or inaccurately filled out, it can cause significant delays because the offices cannot communicate effectively to ensure a smooth transfer of records and care responsibilities.

Another frequent oversight is not adequately detailing the patient's treatment progress and history. The form requires a comprehensive account of the treatment already provided, including any significant patient history, analyses, and a chronology of treatment progress. Skipping details or not providing a thorough explanation can hinder the new orthodontist's ability to seamlessly continue the treatment plan. It is crucial that both orthodontists have a complete understanding of where the patient is in their treatment journey.

Incorrect or incomplete patient information is also a common error. This includes the patient's name, birth date, social security number, and the responsible party's contact information. Mistakes or omissions in this section can create issues with insurance claims, billing, and ensuring the proper medical records accompany the right patient. Accuracy in this area is vital for the legal and financial aspects of the patient’s care.

Lastly, failing to specify or update the financial information correctly can lead to confusion or disputes over payment responsibilities. The form asks for detailed financial information, including the total charges before the transfer, the amount already paid, and any unpaid amount that is still owed. If this section is not filled out correctly, it may result in billing problems, misunderstandings about the remaining balance, and could potentially increase the overall treatment cost for the patient. It's important for both parties to have a clear understanding of the financial arrangements to avoid these issues.

Documents used along the form

When a patient is transitioning from one orthodontic practice to another, the AAO Transfer Form plays a critical role; however, it’s just one of several documents that are often necessary to ensure a smooth and efficient transfer process. Other forms and documents serve to complement the information on the AAO Transfer Form, providing a comprehensive view of the patient’s orthodontic treatment history, financial status, and treatment needs.

  • Medical History Form: This document provides a detailed account of the patient’s medical history, including any allergies, previous surgeries, or ongoing medical treatments. It’s essential for the new orthodontic practice to be aware of these details to ensure the safety and effectiveness of the orthodontic treatment plan.
  • Consent Forms: These include informed consent forms for treatment, privacy consent forms, and any other acknowledgments that confirm the patient or guardian’s agreement to the proposed orthodontic treatment plan and understanding of the privacy practices of the new office.
  • Insurance Information Form: This form collects the patient’s dental insurance details, which is crucial for the new practice to process claims and verify coverage for the continued treatment.
  • Financial Agreement: A document outlining the financial arrangements between the patient (or responsible party) and the orthodontic practice, including payment plans, fees for ongoing treatment, and any charges transferred from the previous provider.
  • Treatment Summary: This comprehensive overview provided by the previous orthodontist details the treatment performed to date, including types of appliances used, duration of treatment, and any pending treatment objectives. It serves to inform the new provider of the current state of progress and future treatment needs.
  • Previous Orthodontic Records: While this is more of a category than a single document, it often includes previous and current panoramic and cephalometric X-rays, molds or digital scans of the teeth, and intraoral and extraoral photographs. These records are critical for the new orthodontist to thoroughly evaluate the patient’s progress and plan the remainder of the treatment.

Together, these documents form a comprehensive package that enables the new orthodontic practice to continue treatment with a clear understanding of the patient’s history, treatment progress, and administrative details. By ensuring these forms and documents are accurately filled out and promptly transferred, the patient can look forward to a seamless transition and the successful completion of their orthodontic treatment.

Similar forms

The AAO Transfer Form is quite similar to a Medical Records Release Form. Both documents are essential in ensuring a seamless transition of patient information from one healthcare provider to another. The Medical Records Release Form authorizes the transfer of a patient's medical history, treatments, and diagnoses, much like the AAO Transfer Form facilitates the exchange of orthodontic treatment details. This ensures new providers have comprehensive knowledge of the patient's background to continue treatment effectively.

Another document similar to the AAO Transfer Form is the Dental Records Transfer form. This specific form is used when a patient decides to change their dentist and needs to transfer their dental history and records. Like the AAO form, it ensures that the receiving dentist is fully informed about the patient's dental condition, previous treatments, and any special considerations or ongoing treatments, facilitating a smooth continuation of care.

The HIPAA Authorization Form also shares similarities with the AAO Transfer Form. It is a legal document that allows an individual's health information to be used or disclosed to a third party. The key similarity lies in the authorization aspect, where both forms require patient consent to transfer sensitive information. However, the HIPAA form is broader, covering any health-related information, while the AAO form is specific to orthodontic records.

The Transfer of Care Document is akin to the AAO Transfer Form in the medical field, particularly used when a patient is transitioning between specialists or healthcare facilities. It typically includes a summary of the patient's current condition, treatment plan, and any critical medical history. The main goal is to ensure continuity of care, a core purpose shared with the AAO Transfer Form, albeit in the orthodontic care context.

School Immunization Records Transfer forms are used when a student moves to a new school and needs to prove vaccination history. Like the AAO Transfer Form, which facilitates the continuity of orthodontic treatment by transferring relevant clinical information, the Immunization Records Transfer ensures that the student meets the new school's health requirements and policies for a safe learning environment.

The Patient Referral Form used by healthcare providers to refer a patient to a specialist shares functions with the AAO Transfer Form. It includes detailed information about the patient's diagnosis, treatment to date, and the reason for referral, ensuring the specialist has all the necessary background to continue the patient's care. This is very much in line with the purpose of the AAO Transfer Form, which is to ensure the smooth transition of orthodontic treatment records to a new orthodontist.

Pharmacy Prescription Transfer Requests are common when patients need to shift their prescription fulfillment to a new pharmacy. This requires detailed information about the patient's medication, dosage, and treatment plan to be shared, similar to how the AAO Transfer Form ensures continuity in orthodontic treatment by sharing detailed treatment plans and progress between orthodontists.

The Release of Information Form in the healthcare sector allows patients to authorize the disclosure of their health information to specified individuals or entities. While broader in scope, this form, like the AAO Transfer Form, plays a crucial role in the seamless transfer of crucial health information, ensuring the recipient is well-informed about the patient's health status or treatment needs.

Continuity of Care Documents (CCDs) are standardized electronic documents exchanged between healthcare providers to ensure seamless transitions in patient care. Like the AAO Transfer Form, CCDs include detailed information about a patient's history, treatment plans, medications, and allergies, focusing on maintaining the continuity and quality of care during transitions between providers.

The Consent to Treat Form is typically used at the onset of a clinical relationship, allowing a healthcare provider to administer treatment to a patient. Similar to the AAO Transfer Form, it involves patient consent and outlines the scope of care agreed upon. While the Consent to Treat Form marks the beginning of treatment, the AAO form ensures that already initiated orthodontic treatments are continued appropriately and effectively when changing providers.

Dos and Don'ts

Filling out an AAO Transfer Form is a critical step in ensuring a smooth transition of orthodontic care. It requires attention to detail and accuracy. Here are some dos and don'ts to help guide you through the process:

  • Do thoroughly review the form before starting to ensure you understand all the requirements.
  • Do fill out the form using clear, legible handwriting if filling it out by hand, to prevent any misunderstandings.
  • Do verify all the patient's information, including name, date of birth, and social security number, for accuracy.
  • Do include comprehensive details in the treatment plan, progress, and special health history sections to provide a complete picture of the patient's orthodontic journey.
  • Don't leave any sections blank. If a section does not apply, mark it as "N/A" (Not Applicable) instead of leaving it empty.
  • Don't forget to sign and date the form where required. Unsigned forms may not be processed, delaying the transfer.
  • Don't overlook the importance of checking the box that corresponds to the correct status of records – whether they are enclosed, sent under separate cover, or duplicates will be sent upon request.
  • Don't hesitate to contact the office you're transferring from or to if you have questions or need clarification about any part of the form or process.

Ensuring all the information is accurate and complete is not just a matter of formality; it's essential for the continued success of the patient's orthodontic treatment. A smooth transfer process benefits everyone involved, most importantly the patient, by facilitating seamless continuation of care.

Misconceptions

When discussing the AAO Transfer Form, several misconceptions often arise, leading to confusion and misunderstandings about the process of transferring a patient's orthodontic care. Clearing up these misconceptions is essential for both patients and orthodontists to ensure smooth transitions and continued care. Below are ten common misconceptions and the truths behind them:

  • The AAO Transfer Form is only needed if the patient is moving out of state. This is incorrect. The form is required for any transfer of care, regardless of the distance involved. It facilitates the smooth continuation of treatment by providing the new orthodontist with critical information.
  • Transferring orthodontic care is a simple process that doesn't require much preparation. In reality, transferring orthodontic care requires careful coordination between the current and receiving orthodontists, including the transfer of detailed patient records to ensure continuity of care.
  • All orthodontists charge the same fees, so financial information on the transfer form is not important. Fees can vary significantly between practices and geographic locations. The financial information on the form is crucial for understanding the patient's financial obligations and ensuring discussions about treatment costs are transparent.
  • The treatment plan does not need to be updated before the transfer. It's actually essential that the current treatment plan, including any recent changes, is clearly documented on the form to provide the receiving orthodontist with up-to-date information.
  • Only the transferring orthodontist needs to sign the AAO Transfer Form. Both the patient (or guardian) and the transferring orthodontist must sign the form to authorize the transfer of records and acknowledge the transfer of care.
  • Patient cooperation and attitudes towards treatment are irrelevant for the transfer. Information about patient cooperation and attitude is incredibly valuable for the new orthodontist. It helps in understanding the patient's compliance and motivation, which can significantly impact the success of the treatment.
  • Diagnostic records are automatically sent to the receiving orthodontist. The current orthodontist will send diagnostic records only upon request and acknowledgment from the patient or guardian. This ensures compliance with privacy laws and standards.
  • The receiving orthodontist will continue treatment exactly where the previous orthodontist left off. While this is the goal, the new orthodontist may adjust the treatment plan based on their assessment of the patient's progress and needs.
  • If all appliances are in place, no additional information is needed from the transferring office. Even if the appliances are in place, detailed information about the treatment progress, including appliance types and adjustments, is crucial for continued care.
  • There are no costs associated with transferring orthodontic records. There may be additional charges for transferring records, especially if duplicates or detailed summaries are requested. It's important for patients to discuss any potential fees with their current orthodontist.

Understanding the realities behind these misconceptions helps ensure patients and orthodontists are well-prepared for the transfer process, ultimately leading to more successful orthodontic treatment outcomes.

Key takeaways

When it comes to transferring orthodontic care mid-treatment, using the AAO Transfer Form ensures a seamless transition for both the patient and the orthodontic practices involved. Here are four key takeaways to keep in mind:

  • Thorough Information Transfer: The AAO Transfer Form covers all bases, including the patient's personal information, detailed treatment plan, progress reports, and any special health concerns. This comprehensive approach facilitates the new orthodontist's understanding of the case, leading to a more efficient and effective continuation of care.
  • Financial Transparency: It addresses financial aspects related to the transfer, including fees paid, unpaid amounts, and an acknowledgment that orthodontic treatment costs can vary by location. This helps manage expectations and provides a clear financial picture to the receiving practitioner and the patient.
  • Record Transfer: The form simplifies the transfer of essential records, including casts, X-rays, and intra-oral scans, which are crucial for the ongoing treatment. It outlines the available records and whether they are enclosed, to be sent separately, or available upon request, ensuring the new orthodontist has all necessary documentation.
  • Patient Cooperation: It includes a section for noting the patient’s level of cooperation, including oral hygiene and adherence to appointments and treatment plan specifics. This insight can help the new orthodontist tailor their approach to motivate and engage the patient effectively for the remainder of their treatment.

Utilizing the AAO Transfer Form plays a pivotal role in ensuring that orthodontic treatment is not disrupted by a change in care providers, making the process as smooth as possible for everyone involved.

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