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Aao Transfer Template

The AAO Transfer Form is a critical document that ensures the smooth transition of a patient's orthodontic treatment and associated records from one provider to another, often due to relocation or other personal circumstances. It encompasses a comprehensive outline of the patient's treatment plan, progress, and any special considerations, alongside essential personal information to facilitate the continuation of care by the new orthodontist. To streamline the transfer process and keep your treatment on track, ensure you complete this form by clicking the button below.

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Table of Contents

Transferring a patient in active orthodontic treatment involves a comprehensive and structured process, as outlined by the American Association of Orthodontists (AAO) through its AAO Transfer Form. This essential document serves multiple critical functions; it ensures the seamless continuation of care by providing the receiving orthodontist with a rich, detailed history of the patient's treatment to date, including analysis, special health concerns, treatment plans, and progress notes. Furthermore, it addresses patient or parent concerns regarding treatment, outlines any specialized appliances used, and assesses patient cooperation. The form also facilitates financial transparency by detailing costs incurred, payments made, and balances owed before the transfer. With sections dedicated to recommendations for continued treatment and retention, this form underscores the importance of thorough communication between orthodontic professionals for the welfare of the patient. Additionally, it guides the process of transferring crucial dental records, underpinning the collective goal of the AAO community to maintain high standards of care, even when patients move or otherwise need to change their care provider.

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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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Form Breakdown

Fact Name	Description
Document Title	AAO Transfer Form
Purpose	Facilitates the transfer of a patient in active orthodontic treatment to another provider.
Relevant Date	Date of the document completion is required.
Parties Involved	Transfer is between two orthodontic providers; from the current (sending) provider to the new (receiving) provider.
Patient Information	Includes patient's name, birth date, sex, Social Security number, and contact information.
Treatment Information	Covers analysis, patient/parent concerns, special health history, treatment plan and progress, appliances used, and patient cooperation.
Financial Information	Includes details about treatment fees, payment terms, and amounts paid or still owed.
Records for Transfer	Lists the types of orthodontic records available for transfer, including initial and progress records.
Authorization Request	A section for the patient or guardian to authorize the release and transfer of records to the new provider.

Guidelines on Filling in Aao Transfer

When changing orthodontists, especially in the midst of ongoing treatment, completing the AAO Transfer Form is a crucial step. This form ensures the seamless transition of care by providing your new orthodontist with all the necessary information about your treatment history, progress, and any specific concerns. Follow these instructions to fill out the form correctly and ensure a smooth transfer process.

Begin by entering the current date at the top of the form where "Date" is indicated.
Fill in the "To" section with the name and contact information of the new orthodontist or orthodontic office receiving the transfer.
Complete the "From" section with your current orthodontist's name and contact information, including phone number, fax number, and email address.
Enter the patient's name, birth date, sex, and social security number in the designated fields.
Provide a contact number and detail the responsible party's name, relationship to the patient, as well as their home address, city, state/province, and zip code.
In the sections labeled Analysis, Patient/Parent Concerns, Special Health or History Concerns, Treatment Plan, and Treatment Progress, summarize relevant information as instructed.
Under the Appliances section, specify details about any fixed, extraoral, removable, and clear tray appliances including type, manufacturer, dates initiated, and hours requested.
Assess and note the patient's cooperation including oral hygiene, headgear use, elastic wear, clear trays maintenance, appointment attendance, and attitude towards treatment.
List any active treatment time estimates, recommendations for continued treatment, retention, and any additional comments necessary for a comprehensive understanding of the patient’s orthodontic journey.
Provide details on the financial aspects of the patient's treatment including fees for active treatment, extras, terms of payment, third-party payments, total charges before transfer, amount paid before transfer, and any remaining balance.
For the section on Available Records for Transfer, check the appropriate boxes indicating what records are available and their statuses, whether they are enclosed, sent under separate cover, or record duplicates are sent upon request.
Lastly, the orthodontist must sign and date the form to authorize the transfer of records.
On the final section for request to transfer records to a new provider, the patient or guardian should authorize the release of records by filling in the names of both the current and new provider, then sign and date the form.

Once the form is fully completed and signed, it facilitates a detailed communication between your current and new orthodontists. This comprehensive transfer of records helps your new orthodontist to continue your treatment with a clear understanding of your orthodontic history, present needs, and future treatment plans. Remember to discuss any questions or concerns with your current orthodontist before submitting the form.

Learn More on Aao Transfer

What is the purpose of the AAO Transfer Form?

The AAO Transfer Form is designed to facilitate the secure and efficient transfer of a patient's orthodontic records and information between orthodontic providers. This form is especially useful when a patient is moving, changing orthodontists for personal reasons, or requires a continuation of treatment under a new orthodontist. Its primary aim is to ensure the new provider receives all necessary information about the patient’s orthodontic condition, treatment goals, treatment plans, financial arrangements, and related records, to continue the treatment effectively.

What information is included in the AAO Transfer Form?

The form includes various sections that cover a comprehensive set of information necessary for the continuation of orthodontic care. These sections include:

Patient identification details, such as name, birth date, and social security number.
Contact information of both the transferring and receiving orthodontists.
A detailed analysis of the patient's dental history, special health concerns, and treatment plan.
Information on appliances used in treatment, patient cooperation, and recommendations for future treatment and retention.
Financial information related to the treatment already provided and the balance owed.
Details on available records for transfer, including casts, cephalometric and panoramic X-rays, intra-oral scans, and photos.

How does the process of transferring records work?

To initiate the transfer of records, the patient or their guardian must authorize the release of their orthodontic records by signing the AAO Transfer Form. This form then serves as a formal request for the current orthodontist to send the patient’s records to the new orthodontist. Records can be sent directly with the form, under a separate cover, or made available upon request, with some orthodontists possibly charging an additional fee for duplicating records.

Are there any financial implications for transferring orthodontic care?

Yes, the form clearly mentions that orthodontic treatment fees vary widely, and transferring to a new orthodontist could potentially increase the total cost of treatment. It also states that the patient or their responsible party has been made aware that changes in payment policies may apply with the new provider. This section helps ensure transparency about possible financial changes as a result of the transfer.

What should a patient consider before requesting a record transfer?

Before requesting a transfer, patients should consider several factors:

The potential for increased treatment costs and changes to payment policies with the new provider.
The importance of transferring all relevant records to ensure continuity and quality of care.
Finding a qualified orthodontist who is a member of the American Association of Orthodontists and can seamlessly continue the treatment.
The necessity of completing the AAO Transfer Form accurately to help prevent delays in the continuation of care.

Common mistakes

Filling out the AAO Transfer form is critical for ensuring the smooth transition of orthodontic care, but it's also a process where many can make mistakes due to oversight or misunderstanding. Here are nine common errors:

Not verifying personal information: It's essential to double-check the spelling of the patient's name, their Social Security number, and their birth date. Mistyped information can lead to misidentification and delays.
Skipping contact details: Failing to fill out complete contact information for both the transferring and receiving offices can impede communication, hindering the transfer process.
Incomplete treatment details: Not providing a detailed account of the patient’s treatment progress, including appliances used and treatment dates, can result in unnecessary repetition or omission of crucial steps by the new provider.
Omitting financial information: Not disclosing the financial status of the patient’s account, including any outstanding balance or payments already made, can lead to billing complications.
Overlooking patient cooperation notes: Failing to share insights on the patient's cooperation, attitude towards treatment, and motivation can leave the new orthodontist unprepared for potential challenges.
Unclear recommendations for continued treatment: Vague or incomplete recommendations can cause confusion and potentially disrupt the continuity of care.
Neglecting to report on special health concerns: Special health or history concerns critical to the orthodontic treatment must be thoroughly communicated to ensure the patient’s safety and treatment efficacy.
Forgetting to specify the appliance types: Not detailing the exact types of appliances used (e.g., type of brackets, wires, elastics) can result in mismatched or inappropriate continuation of treatment.
Inadequate record transfer arrangements: Failing to correctly indicate the status of record transfers or not securing the patient's or guardian’s authorization for release complicates and delays the handover process.

Avoiding these mistakes requires careful attention to detail and a thorough understanding of the documentation required for a successful orthodontic transfer. Ensuring all sections of the AAO Transfer form are completed fully and accurately can significantly impact the ease of transition for the patient and the continuity of their care.

Documents used along the form

When initiating the transfer of a patient in active orthodontic treatment, as outlined in the AAO Transfer Form, several additional forms and documents are typically required to ensure a smooth and efficient transition. These supplementary forms ensure the receiving orthodontist has all necessary information to continue the patient's care effectively.

Medical History Form: This comprehensive document provides a detailed overview of the patient's overall health, including past medical history, current medications, allergies, and any specific health conditions that could affect orthodontic treatment.
Insurance Information Form: Essential for financial arrangements, this form gathers the patient's dental insurance details, helping the new orthodontist's office manage claims and understand coverage limits and pre-approvals.
Consent Forms: Informed consent forms are crucial for outlining the risks, benefits, and alternatives of the proposed orthodontic treatment, ensuring the patient or their guardian understands the scope of care and any potential outcomes.
Treatment Summary Report: A narrative summary or report provided by the initial orthodontic practice that details the treatment plan, progress made, appliances used, and any complications or deviations from the original treatment objectives.
Photographic Records: High-quality images of the patient's face, teeth, and smile captured during the initial consultation and throughout treatment, offering a visual reference for assessment and planning.
Financial Agreement: Documentation of the original financial arrangement between the patient (or responsible party) and the initial orthodontic practice, including details on payments made, balance owing, and any agreed-upon insurance billing arrangements.

Combining these documents with the AAO Transfer Form provides a thorough patient profile, ensuring the receiving orthodontist has a complete understanding of the patient's orthodontic history, treatment needs, and financial arrangements. This comprehensive approach minimizes disruptions, ensuring the patient's treatment continues smoothly and efficiently towards achieving a successful outcome.

Similar forms

The Medical Record Transfer Form is similar to the AAO Transfer Form because both involve sharing detailed medical or treatment histories between healthcare providers. This form will typically include the patient's personal details, relevant medical history, current medications, and specific instructions regarding the patient's ongoing care, mirroring the process and intent behind transferring orthodontic treatment details.
The Referral Form used by general dentists or medical practitioners shares similarities with the AAO Transfer Form by including patient information, the reason for referral, an analysis of the patient’s condition, and what specific consultation or treatment is being sought from another specialist, ensuring continuity of care.
The Dental Health History Form is akin to the AAO Transfer Form in that it compiles an individual's dental history, including past procedures, ongoing treatments, allergies, and patient concerns, which are crucial for informing future dental treatment plans.
The Consent Form for Orthodontic Treatment parallels the aspect of the AAO Transfer Form concerned with patient or parent concerns and treatment consent, laying out the scope of treatment, risks, benefits, and alternatives, and thus requiring informed consent from the patient or their guardian.
The Education Record Transfer Form found in school settings, while not medical, is similar in its purpose to ensure a smooth transition by transferring essential personal and academic information, including any special needs or accommodations, from one educational institution to another.
The Treatment Plan Form used in various healthcare settings, including mental health and general medical practice, shares the objective of outlining proposed treatments, including goals, methods, and progress tracking, akin to the treatment plan and treatment progress sections of the AAO Transfer Form.
The Prescription Form has similarities with parts of the AAO Transfer Form that involve specific treatment tools or appliances, as both convey detailed instructions from a healthcare provider to another party responsible for part of the patient’s treatment, such as pharmacies or dental appliance manufacturers.
The Patient Satisfaction Survey, while primarily focused on gathering feedback, indirectly shares the goal of improving patient care through understanding their experience, concerns, and outcomes, much like how the AAO Transfer Form aims to ensure continued, patient-customized care post-transfer.

Dos and Don'ts

When working with the AAO Transfer form, it's crucial to pay attention to both what should and shouldn't be done for a smooth transition. Here are key points to consider:

Do:

Ensure all the information is accurate. Double-check the patient's name, birth date, social security number, and contact information for accuracy.
Fill out the form completely. Every section should be reviewed and filled out to ensure the receiving orthodontist has a full understanding of the patient’s treatment history and current needs.
Describe the treatment plan and progress in detail. This includes a thorough outline of what has been done and what is still planned, as well as any special health or history concerns that the next orthodontist should be aware of.
List all appliances used, including types, manufacturers, and dates of placement. This is vital for the continuing care and treatment of the patient.
Discuss patient cooperation fully. This includes oral hygiene, attitude towards treatment, and adherence to appointments and treatment plan requirements.
Provide complete financial information. This should cover not only the fees and payments made but also the financial terms and any balance still owed to ensure transparency in financial responsibilities post-transfer.

Don't:

Leave any sections blank. If a section does not apply, indicate with “N/A” (Not Applicable) instead of leaving it empty. This avoids confusion and clarifies that the section was not overlooked.
Guess on dates or details. If unsure, it's better to verify the information before submitting the form to avoid any errors that could affect the patient's treatment continuity.
Omit any appliance or treatment detail. Every piece of information is crucial for the new orthodontist to continue treatment effectively.
Forget to include the patient or guardian’s signature for record release. This is a legal requirement for the transfer of medical records and treatment continuation.
Assume the new orthodontist has the same treatment philosophies or financial policies. Be transparent about all aspects of treatment, including any unfinished or anticipated procedures, to manage expectations.
Neglect to check the appropriate status of available records for transfer, such as whether records are enclosed or will be sent under separate cover. This ensures all necessary documentation accompanies the form for a comprehensive handover.

Misconceptions

When discussing the AAO Transfer form, commonly used in the orthodontics field for transferring a patient's care from one provider to another, several misconceptions often arise. This document, while straightforward, carries with it an array of assumptions that need clarification. Here are six of the most common misconceptions and the truth behind each:

Any dentist can complete and transfer the AAO form: This belief is not accurate. The AAO Transfer form is specifically designed for orthodontists, who are specialists in the field. While a general dentist can initiate the process in certain circumstances, the form is intended for and best completed by an orthodontist, ensuring that all necessary orthodontic records and details are accurately conveyed to the new provider.
The form transfers all patient responsibilities to the new orthodontist: While the AAO Transfer form does facilitate the transfer of patient records and care responsibility, it doesn't automatically transfer all past agreements. For example, financial agreements and certain responsibilities previously agreed upon with the initial provider may not transfer and could require negotiation and re-establishment with the new provider.
Completion of the form finalizes the transfer of care: Simply completing and submitting the form does not finalize the transfer of care. The new orthodontist must review the records, accept the patient into their care, and potentially, new assessments may be required. This process ensures a smooth transition and the continuation of appropriate treatment plans.
There is no need for patient or guardian consent to transfer records: Consent is paramount when transferring medical records, including orthodontic records. The AAO Transfer form requires a signature from the patient or the patient's guardian to legally authorize the release and transfer of records. This step ensures compliance with privacy laws and protects patient rights.
All orthodontists will accept transferred patients without hesitation: While many orthodontists are willing to accept patients transferring from another practice, acceptance is not guaranteed. Each case is unique, and the new orthodontist will need to review the patient's records and treatment plan to ensure they can provide the necessary care before agreeing to the transfer.
There are no additional fees involved in transferring orthodontic care: Transferring to a new orthodontist may involve additional fees. These can include costs for record transfer, initial assessment by the new care provider, and potential differences in treatment plans that may require different or additional procedures. Patients and their families should be prepared for the possibility of incurring these additional costs.

Understanding these nuances is crucial for patients and their families considering an orthodontic transfer. By dispelling these misconceptions, one can approach the transfer process with a clearer perspective, ensuring smoother transitions and continued optimal care.

Key takeaways

Fulfilling the AAO Transfer Form requires meticulous attention to detail and conscious consideration of all stakeholders involved. Here are five key takeaways to ensure that the process is carried out smoothly and effectively:

To initiate the process, accurately fill out all sections of the form, including patient information, treatment details, and current orthodontic appliance(s) being used. This comprehensive data collection supports a seamless transition in care.
For those in active treatment, it's crucial to communicate the specific orthodontic progress, including appliances used, treatment rendered, and any special considerations such as health concerns, to maintain the continuity and quality of care.
Understanding the financial implications is vital. The form outlines the financial status of the treatment, including fees paid, amounts still owed, and the possibility of additional charges post-transfer. It candidly addresses expectations regarding potential variations in treatment costs upon changing providers.
It is important to accurately list and provide all available orthodontic records for transfer. These records, including initial and progress casts, cephalometric analyses, panoramic and CBCT images, and intraoral photographs, are essential for the new provider's understanding of the case and the continuation of effective treatment.
Finally, the form emphasizes the importance of mutual consent and understanding, highlighted by the necessity for signatures from both the transferring orthodontist and the patient or guardian. This formalizes the agreement and understanding regarding the transfer of records and the continuation of orthodontic treatment, ensuring that both parties are informed and agreeable to the planned proceedings.

In summary, the AAO Transfer Form plays a critical role in facilitating a smooth transition for patients undergoing orthodontic treatment. By providing detailed information about the patient's treatment progress, financial aspects, and expressing clear consent for the transfer, it ensures that high-quality care continues uninterrupted. Patients and orthodontists are encouraged to handle this form with the seriousness it warrants, ensuring clarity, transparency, and the patient's well-being throughout the transfer process.

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