The Aao Transfer Form is a crucial document used when a patient needs to change orthodontic providers during their active treatment. This form ensures that all relevant patient information, including treatment history and financial arrangements, is seamlessly transferred to the new orthodontist. By facilitating this process, the form helps maintain continuity of care and supports the patient's ongoing treatment journey.
The Aao Transfer form serves as a critical document in the continuity of orthodontic care for patients undergoing active treatment. This form facilitates the seamless transition of patient records from one orthodontist to another, ensuring that the new provider has all the necessary information to continue treatment effectively. Key components of the form include patient identification details, treatment history, and specific concerns raised by the patient or their guardians. Additionally, it outlines the treatment plan, progress made, and any appliances currently in use. Financial considerations are also documented, including fees paid and outstanding balances, which helps clarify the financial obligations of the patient during the transfer. Furthermore, the form emphasizes the importance of thorough communication between the transferring and receiving orthodontists, as well as the need for the patient to understand potential changes in treatment costs and payment policies. In essence, the Aao Transfer form is not just a bureaucratic tool; it is a vital link that supports the patient’s journey through orthodontic care, ensuring that their needs are met even amidst changes in their treatment environment.
What is the purpose of the AAO Transfer Form?
The AAO Transfer Form is designed to facilitate the transfer of orthodontic records when a patient changes providers. This ensures that the new orthodontist has all necessary information about the patient's treatment history, current status, and future treatment plans. Proper documentation is crucial for maintaining continuity of care and ensuring effective treatment.
Who needs to fill out the AAO Transfer Form?
The form must be completed by the current orthodontist or their office staff, along with the patient or guardian. This collaboration ensures that all relevant details about the patient's treatment and medical history are accurately conveyed to the new provider.
What information is required on the AAO Transfer Form?
The form requires detailed information, including patient demographics, treatment history, appliances used, patient cooperation, financial arrangements, and recommendations for continued treatment. This comprehensive data allows the new orthodontist to understand the patient's situation fully.
How does the transfer process affect treatment costs?
Patients should be aware that transferring during orthodontic treatment may lead to increased costs. Fees for treatment can vary significantly between providers. It is essential for patients to discuss potential changes in payment policies and overall treatment costs with their new orthodontist.
What types of records are included in the transfer?
The transfer may include various records, such as casts, cephalometric tracings, panoramic x-rays, intraoral scans, and photographs. The form allows the current orthodontist to specify which records are being sent, ensuring that the new provider has the necessary information to continue treatment effectively.
Can patients request duplicates of their records?
Yes, patients can request duplicates of their records. However, this may incur an additional charge. The AAO Transfer Form includes a section where the current orthodontist can indicate whether duplicates are available upon request.
What should patients do if they have concerns about their treatment during the transfer?
If patients have concerns about their treatment while transferring, they should communicate these issues clearly on the form. The section for patient or parent concerns allows for specific issues to be addressed, ensuring that the new orthodontist is aware of any challenges or expectations as treatment continues.
Filling out and using the AAO Transfer Form is an important step in ensuring a smooth transition of orthodontic care. Here are some key takeaways to keep in mind:
By following these guidelines, the process of transferring orthodontic care can be made more efficient and effective for all parties involved.
This form is designed for any patient who needs to transfer their orthodontic records, regardless of their satisfaction level. Life changes, such as moving or scheduling conflicts, can necessitate a transfer.
While the form facilitates record transfer, acceptance ultimately depends on the new orthodontist's availability and willingness to take on new patients.
The form is straightforward. Patients or guardians can complete it with basic information about the patient and their treatment history.
In many cases, transferring records can be done quickly. Prompt communication between the current and new orthodontists helps minimize any delays.
Some orthodontists may charge for record duplication or transfer, but many do not. It’s best to check with both the current and new orthodontist regarding any potential fees.
Even patients who have completed their treatment may need to transfer records for follow-up care or retention purposes.
The purpose of the Aao Transfer form is to ensure that all relevant treatment history and records are shared with the new orthodontist, preserving continuity of care.
Each orthodontist may have different procedures for accepting transfers. It’s important to communicate directly with the new provider to understand their specific requirements.
Adults seeking orthodontic treatment can also use this form. The need for record transfer applies to patients of all ages.
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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Incomplete Patient Information: Failing to provide complete details such as the patient's name, birth date, or Social Security number can delay the transfer process. Ensure all fields are filled accurately.
Omitting Treatment History: Not including a comprehensive treatment history can hinder the new orthodontist's ability to provide effective care. Detail every aspect of the treatment rendered.
Ignoring Financial Details: Overlooking the financial section can lead to misunderstandings regarding unpaid balances or fees. Clearly state any outstanding amounts or payment policies.
Neglecting to Sign: Failing to sign the form or provide the date can render the transfer invalid. Always ensure that both the patient or guardian and the orthodontist have signed.
Not Checking Record Status: Forgetting to indicate whether records are enclosed or sent separately can complicate the transfer. Confirm the status of all records before submission.
When filling out the AAO Transfer form, consider the following dos and don'ts:
The Aao Transfer form shares similarities with the Patient Referral Form. Both documents serve the purpose of transferring a patient’s information from one healthcare provider to another. The Patient Referral Form typically includes sections for patient demographics, medical history, and specific concerns that the new provider should be aware of. Just like the Aao Transfer form, it emphasizes the need for continuity of care by ensuring that the new provider has access to all relevant information regarding the patient's treatment and needs.
Another document akin to the Aao Transfer form is the Medical Records Release Form. This form is essential for patients who wish to have their medical records shared with a new provider. It requires the patient’s consent to release their information, similar to how the Aao Transfer form authorizes the transfer of orthodontic records. Both forms prioritize patient privacy and ensure that only authorized individuals can access sensitive health information.
The Treatment Summary Form also resembles the Aao Transfer form in its focus on documenting a patient's treatment history. This form summarizes the treatments that have been administered, including progress notes and future recommendations. Like the Aao Transfer form, it provides a detailed overview that aids the new provider in understanding the patient's ongoing care requirements.
The Continuity of Care Document (CCD) is another related document. It is designed to ensure that all pertinent patient information is available when a patient transitions between healthcare providers. The CCD includes clinical summaries, medication lists, and treatment plans, paralleling the comprehensive nature of the Aao Transfer form, which details treatment progress and patient cooperation.
The Orthodontic Treatment Record is similar as well. This document captures a detailed account of the orthodontic procedures performed on a patient. It includes information on appliances used, treatment timelines, and patient compliance. Both forms aim to provide the new orthodontist with a complete picture of the patient's treatment journey, ensuring that they can continue care without interruption.
When it comes to managing financial transactions, understanding documents such as the Promissory Note is essential. This written promise outlines the obligations for both borrowers and lenders, ensuring clarity and compliance with agreed-upon terms, similar to how the aforementioned forms facilitate clear communication in healthcare settings.
Another comparable document is the Patient Transfer Authorization Form. This form explicitly grants permission for one provider to transfer a patient’s care to another provider. It contains sections for patient information and the reasons for the transfer, much like the Aao Transfer form, which outlines the patient’s treatment status and ongoing needs.
Finally, the Insurance Information Transfer Form is similar in that it handles the financial aspects of patient care during a transfer. This form collects information about insurance coverage and outstanding balances, ensuring that the new provider is aware of the financial arrangements. Like the Aao Transfer form, it addresses the importance of clear communication regarding financial responsibilities during the transition of care.