The AAO Transfer Form is designed to streamline the process of transferring a patient's orthodontic treatment records from one provider to another. This document ensures the seamless continuation of care by providing comprehensive details about the patient's treatment plan, progress, and any special considerations. If you're undergoing a transition in your orthodontic care, filling out this form is a crucial step. Click the button below to begin the process.
When patients are undergoing orthodontic treatment and need to switch providers due to moving or other factors, the AAO Transfer Form plays a crucial role in ensuring a smooth transition. Designed by the American Association of Orthodontists, this important document facilitates the transfer of a patient's detailed orthodontic records to a new orthodontist. It includes comprehensive information such as the patient's active treatment status, significant health history, current treatment plan, appliances used, and progress made, among other critical details. Additionally, it outlines the financial implications of the transfer, emphasizes the potential need for adjusted treatment fees, and suggests that costs might increase with the change in providers. With spaces designated for both the former and the new orthodontist’s details, it also officially authorizes the release and receipt of these records. This form ensures continuity of care, allowing the new provider to be fully informed about past treatments and future needs, guaranteeing patients’ orthodontic journeys are not hindered by their relocation or change in circumstances.
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
Panoramic
CBCT
Intra-oral scan
files
Intraoral x-rays
Facial photos
Intraoral photos
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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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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Completing the AAO Transfer Form is a crucial step in ensuring a smooth and effective transition for a patient who is undergoing orthodontic treatment and needs to transfer to a new provider. This form serves as a detailed communication tool between the current and future orthodontic offices. It covers essential information such as patient's treatment history, concerns, progress, and financial details, along with recommendations for future treatment. The process of filling out this form thoroughly will aid in maintaining the continuity and quality of care.
Upon completion, ensure that the form, along with any physical or digital records indicated as available for transfer, are sent promptly to the new provider. This will enable the new orthodontic office to review the patient's history and treatment plan, ensuring they can continue the treatment effectively without unnecessary delays or repetition of procedures.
What is an AAO Transfer Form and when is it used?
An AAO Transfer Form is a document used in the field of orthodontics when a patient in active treatment needs to transfer from one orthodontic office to another. This could be due to moving to a new area, changes in insurance, or personal preference. The form facilitates the smooth transfer of a patient's treatment plans, records, and financial information to ensure continuity of care.
How is patient information protected during the transfer process?
Patient information is handled with strict confidentiality during the transfer process. The form itself is a part of a professional and regulated process that respects patient privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA) in the United States. Records are only released with the consent of the patient or the patient’s guardian, as indicated by a signature on the form.
What information is included in the AAO Transfer Form?
The AAO Transfer Form includes comprehensive information necessary for the continuation of orthodontic care. This includes the patient's personal details, significant medical and dental history, details of the treatment plan and progress, patient cooperation, and financial information related to the treatment. Additionally, it lists available records for transfer such as x-rays, photographs, and dental casts.
Who completes the AAO Transfer Form?
The current orthodontist (or their administrative staff) typically initiates the filling out of the AAO Transfer Form once the patient or guardian has requested a transfer. The patient or guardian also provides authorization on the form for the release and transfer of records. The receiving orthodontist may also contribute by specifying the records needed for the continuation of care.
Can the receiving orthodontist refuse to accept a transferred patient?
While it is generally in the best interest of the patient for orthodontists to facilitate transfers, the receiving orthodontist has the discretion to accept or refuse a new patient based on their capacity, expertise, and other factors. However, the American Association of Orthodontists encourages its members to assist in these cases to ensure patients have access to continuous care.
How do financial arrangements work with a transfer?
The AAO Transfer Form includes detailed financial information such as the balance of the original quoted fee, any unpaid amounts, and payments made before the transfer. This information helps the receiving orthodontist understand the financial status of the treatment. However, the patient should be aware that transferring care could lead to changes in the cost of treatment depending on the new provider’s policies and treatment plans.
What happens if a patient moves before treatment is completed?
If a patient moves before completing their orthodontic treatment, the AAO Transfer Form plays a crucial role in ensuring a seamless transition to a new orthodontist. It allows the patient's new provider to promptly continue the treatment based on the detailed history and progress reported by the previous orthodontist. However, it’s important for the patient to discuss potential changes in treatment plans and costs with the new provider.
When individuals are tasked with completing the AAO Transfer Form, specifically related to transferring an orthodontic patient's ongoing treatment to a new provider, several common mistakes often occur. These errors can delay the process, lead to incomplete information transfer, or even cause unnecessary complications in continuing care. Here are five typical mistakes:
Not verifying the accuracy of personal information. It’s crucial to double-check the patient's name, birth date, and social security number. Any discrepancies in these details can lead to confusion or a mismatch of records at the new orthodontic office.
Failing to provide comprehensive treatment details. The sections under "ANALYSIS," "TREATMENT PLAN," and "TREATMENT PROGRESS," require detailed information. Sometimes, individuals provide only brief summaries or overlook significant aspects of the treatment, such as specific appliances used or key milestones in the treatment chronology.
Omitting the patient/parent concerns and special health history. This oversight can lead to a lack of awareness on the part of the new provider regarding the patient's specific needs or concerns, as well as potentially relevant health issues that could impact orthodontic treatment.
Incomplete details on the financial arrangement. The "FINANCIAL" section is sometimes filled out hastily, with important details about the fees, balance, and any third-party payments being left vague or incomplete. This lack of clarity can cause disputes or misunderstandings about financial responsibilities after the transfer.
Neglecting to include or specify the available records for transfer. The form asks for a list of records that are available for transfer, including casts, x-rays, and intraoral scans, among others. Not checking off the appropriate boxes or failing to send these records promptly can significantly delay the new provider's ability to continue treatment effectively.
Avoiding these mistakes requires careful attention to detail and a thorough understanding of the treatment history and current status. By ensuring that the AAO Transfer Form is accurately and completely filled out, patients and their guardians can facilitate a smoother transition to a new orthodontic provider, thus maintaining the continuity and quality of care.
When managing an AAO Transfer Form, which is essential during the transfer of a patient mid-treatment from one orthodontist to another, several additional documents often accompany this form to ensure a smooth and comprehensive transition. These documents play a critical role in providing the new orthodontic provider with a full understanding of the patient's orthodontic journey, any special health considerations, and the financial aspects of their treatment plan.
Collectively, these documents, alongside the AAO Transfer Form, enable orthodontic care providers to maintain continuity and quality in patient treatment after a transfer. They ensure that the receiving provider has all necessary information, fostering informed decisions and strategic planning to achieve the desired treatment outcomes.
The HIPAA Release Form is similar as it facilitates the transfer of confidential patient health information between healthcare providers or to the patient, ensuring that the recipient is authorized to receive such information, akin to the transfer of orthodontic records and treatment details between orthodontists.
The Medical Records Release Form mirrors this function by authorizing the sharing of a patient's medical history, treatments, and diagnoses between healthcare professionals for continued patient care, similar to how orthodontic records are shared for ongoing treatment.
A Referral Form used by doctors to refer patients to specialists shares similarities, as it includes patient information, the reason for referral, and the medical history relevant to the specialist’s treatment plan, paralleling the transfer of necessary information for continuing orthodontic care.
The Consent to Treat Form is akin because it involves obtaining permission from the patient or guardian to proceed with the recommended medical or dental treatments, ensuring understanding and agreement on the procedures and their outcomes, similar to gaining consent for ongoing orthodontic treatment after a transfer.
A Treatment Plan Form outlines the proposed medical or dental interventions, timelines, goals, and expected outcomes for a patient, corresponding to the comprehensive plan detailed in the transfer form for the continuation of orthodontic care.
The New Patient Registration Form collects detailed personal, insurance, and medical history information from patients at their initial visit to a healthcare provider, similar to the background and treatment history required for transferring an orthodontic patient.
An Insurance Authorization Form is needed to verify and obtain approval for treatment coverage from the patient's insurance company, akin to the financial information and third-party payment details that might be shared between orthodontists during a treatment transfer.
The Patient Transfer Form used in hospitals for when a patient is moved from one department to another resembles the AAO Transfer Form as it ensures all relevant health information accompanies the patient for seamless continuation of care.
A Dental Claim Form used for submitting treatment details to insurance companies for payment parallels the sharing of treatment specifics and financial details necessary for continued orthodontic care coverage after a patient transfer.
When filling out the AAO Transfer form, it’s important to handle the details with care. To make sure you complete this form correctly and efficiently, consider the following dos and don'ts:
When discussing the Administrative Appeals Office (AAO) Transfer Form, there are several common misconceptions. Addressing these can clarify the process and ensure a smoother transition during an individual's orthodontic care.
Misconception 1: The AAO Transfer Form is only for transferring a patient's physical records.
This form not only facilitates the transfer of physical records but also includes important details about the patient's treatment plan, treatment progress, and financial information, offering a comprehensive overview that assists the new provider in continuing care seamlessly.
Misconception 2: The form is the same as giving consent for the transfer of care.
While the form does contain sections for transferring records, explicit consent from the patient or guardian is required for the actual transfer of care, highlighting the importance of informed consent in the process.
Misconception 3: All orthodontists require this form for a transfer.
The necessity of this form can vary by practice. It is designed to standardize the transfer process but might not be mandatory for all orthodontists, especially if alternative procedures are in place.
Misconception 4: The form itself initiates the transfer process.
The submission of the form is a step in the process but does not initiate the transfer. Coordination between the current and new provider, along with the patient's explicit consent, are essential for initiating the transfer.
Misconception 5: Patient cooperation information is not vital for the transfer.
Details about patient cooperation, such as oral hygiene practices and adherence to treatment protocols, are critical for the new orthodontist. This information can significantly influence the continuation and success of treatment.
Misconception 6: The form covers all details necessary for the transfer.
While comprehensive, the form might not include all information relevant to the patient's care. Direct communication between the orthodontists might still be necessary to cover specific concerns or treatment nuances.
Misconception 7: The transfer form is solely for the patient's benefit.
The form is designed not only to benefit the patient by ensuring continuity of care but also to assist both the former and the new orthodontist in terms of legal compliance, clear communication, and understanding the financial aspects of the treatment.
Understanding these misconceptions can help patients and guardians navigate the orthodontic transfer process more effectively, ensuring that transitions in care proceed smoothly and with informed consent.
When it comes to the process of transferring a patient's orthodontic care, using the AAO Transfer Form is a crucial step for ensuring a seamless transition. Here are some key takeaways to keep in mind:
Transferring orthodontic care using the AAO Transfer Form helps communicate vital information between providers, ensuring that patient care remains consistent and is effectively continued with the new orthodontist.
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