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Fill Out Your Aao Transfer Form

The Aao Transfer Form is a document designed to facilitate the transfer of patient records between orthodontic providers. This form ensures that crucial information about a patient’s ongoing treatment and financial arrangements is efficiently shared. For those looking to complete the transfer, fill out the form by clicking the button below.

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Article Structure

The Aao Transfer Form serves a crucial role for patients undergoing orthodontic treatment who need to switch providers for any reason. This comprehensive document gathers essential patient information, including personal details, treatment history, and specific concerns that have arisen during the orthodontic process. The form highlights the patient's treatment journey, detailing significant developments, appliances used, and the patient's cooperation throughout the procedure. Additionally, it includes the financial aspects associated with the treatment, making clear any outstanding balances and the anticipated financial implications of transferring care. Notably, there is a section dedicated to transferring medical records, ensuring that the new orthodontist is fully apprised of the patient's condition and treatment plan. This form not only streamlines the transition but also facilitates effective communication between the old and new providers, thus enhancing the overall experience for the patient and minimizing interruptions in their treatment journey.

Aao Transfer 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 _________________________________________

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 Characteristics

Fact Name	Description
Purpose of Form	The Aao Transfer Form is designed to facilitate the transfer of patient records between orthodontic providers.
Patient Identification	The form collects essential patient information, including name, birth date, and social security number.
Active Treatment Status	It identifies whether the patient is currently in active treatment, ensuring continuity of care.
Health Concerns	Special health or history concerns are documented to provide the new provider with crucial background information.
Financial Arrangement	The form includes sections detailing the financial status, including fees paid and any balances due.
Record Availability	It specifies what records are available for transfer, such as casts and x-rays.
Patient Cooperation	Information on patient cooperation is gathered to assess engagement in treatment.
Recommendations	Section for recommendations regarding continued treatment and retention is included.
Transfer Acknowledgment	Patients must acknowledge that treatment fees may vary following the transfer.
Authority to Transfer	Patients grant permission for their records to be transferred to the new provider by signing the form.

Guidelines on Utilizing Aao Transfer

Completing the AAO Transfer form is crucial for ensuring a smooth transition between orthodontic providers. This form gathers essential information about the patient's ongoing treatment and communicates it to the new provider. Below are the steps to fill out the form accurately:

Enter today's date in the space provided at the top.
Fill in the 'To' field with the name of the new provider and their contact information, including phone, fax, and email.
In the 'From' field, write the name of the current provider, along with their contact details.
Complete the patient's personal information, including their name, birth date, sex, and social security number.
List the responsible party's name, relationship to the patient, and their home address, including city, state/province, and zip code.
Provide a detailed analysis of the patient's significant history and any concerns related to TMD.
Document any concerns the patient or parent has regarding treatment.
Outline the treatment plan, including a chronology of treatment that has been rendered thus far.
Summarize treatment progress, again indicating the chronology of what has been done.
Detail the appliances used, including fixed, extraoral, removable, and clear tray appliances.
Evaluate patient cooperation in various areas, from oral hygiene to adherence to appointments.
Estimate active treatment time, noting both original and remaining time, along with the percentage of completion.
List recommendations for continued treatment and retention.
Add any additional comments that may assist the new provider.
Provide the financial information related to the patient's treatment, including fees and payment history.
Note which records are available for transfer and indicate the relevant dates.
Sign and date the form in the designated space, confirming the information provided.

Once completed, this form will be essential for the new provider to understand the patient's ongoing orthodontic needs and make the transition as seamless as possible.

What You Should Know About This Form

What is the purpose of the AAO Transfer Form?

The AAO Transfer Form is designed to facilitate the transfer of a patient's orthodontic records from one orthodontist to another. This is particularly useful when a patient moves or chooses to switch providers during ongoing treatment. The form ensures that the new orthodontist has all relevant information about the patient's treatment history, current status, and any financial obligations. The goal is to enable a smooth transition and continued care without any disruption.

What information is required to complete the AAO Transfer Form?

Essential information includes the patient's personal details, such as name, birth date, and contact information. It also requires details about the patient's current treatment plan, history, and any specific concerns from the patient or their parents. Additional sections cover treatment progress, appliances used, and cooperation levels. Financial information, including fees and any outstanding balances, is also necessary for transparency between both orthodontists.

How can I request the transfer of my orthodontic records?

To request the transfer of orthodontic records, fill out the AAO Transfer Form with the relevant patient details, including the name of the current orthodontist and the new provider. The patient or guardian must sign the authorization section to grant permission for the release of records. Once the form is completed, submit it to the current orthodontist’s office, which will process the request promptly.

Can I transfer my records if I am still in the middle of treatment?

Yes, you can transfer your records even if you are in the middle of treatment. The AAO Transfer Form is specifically designed for such situations. However, keep in mind that transferring during active treatment may result in changes to your treatment fees and payment policies. The new orthodontist should discuss these changes with you as part of their onboarding process.

What should I expect after transferring my records?

After the records are transferred, the new orthodontist will review them to understand your previous treatment and make an informed decision about your ongoing care. They may schedule an initial consultation to discuss your treatment plan, progress, and any necessary adjustments. It is also important to clarify financial obligations and ensure that both parties are on the same page.

Will I incur any additional costs when transferring to a new orthodontist?

It is possible that you may incur additional costs when transferring to a new orthodontist. Orthodontic treatment fees can vary widely across different practices. The transfer may increase your overall treatment costs, and it is advisable to discuss potential fees and payment options with the new provider before moving forward.

How can I ensure my new orthodontist has all necessary records?

To ensure that the new orthodontist receives all necessary records, complete the AAO Transfer Form thoroughly with accurate information. Clearly state what documents are to be transferred, such as radiographs, treatment history, and financial details. The current office is responsible for sending these records, but you can follow up to confirm that everything is in order.

Common mistakes

When filling out the AAO Transfer form, one common mistake is leaving important fields blank. Every section must be completed to provide a clear understanding of the patient’s status and history. Information about the patient’s current treatment and orthodontic records is crucial. An incomplete form may lead to delays and misunderstandings between the current and new providers.

Another mistake people often make is failing to provide accurate contact information. This includes phone numbers and email addresses. If the new provider needs to reach the patient or their responsible party for follow-up, missing or incorrect information can lead to confusion. Clear communication channels are essential for a seamless transition.

Some individuals rush through the analysis section, overlooking key details of the patient's medical history and previous treatment progress. This section helps the new orthodontist understand the patient's unique circumstances. Omitting significant information can lead to a lack of continuity in care. It's important to take time and provide a thorough account of any previous concerns and treatment outcomes.

Additionally, patients sometimes neglect to sign the authorization section properly. This is a critical step, as it gives the current orthodontist permission to release records to the new provider. An unsigned authorization could result in the new clinician not receiving the necessary information to continue treatment, which may burden the patient further.

Lastly, a frequent error is not discussing financial details adequately. Patients may overlook filling in payment information and assumptions about fees with the new provider. It's important to have clarity about any outstanding balances or financial arrangements to prevent misunderstandings later. Transparency regarding finances helps ensure that everyone involved is on the same page, promoting a smoother transition between orthdontic care providers.

Documents used along the form

When transferring care from one orthodontist to another, several forms and documents may be needed alongside the AAO Transfer Form. Each of these documents plays a crucial role in ensuring a smooth transition for the patient.

Patient Consent Form: This document confirms the patient's agreement to transfer their dental records to a new provider. It must be signed by the patient or their guardian.
Record Release Authorization: Similar to the consent form, this authorization legally allows the current orthodontist to share records with the new orthodontist. It usually specifies which records are being transferred.
Patient Treatment History: A detailed summary of the patient’s treatment progress, including any previous procedures and outcomes. This helps the new provider understand the patient's history in depth.
Financial Statement: This outlines outstanding balances, payment history, and any financial arrangements that may affect ongoing treatment. Clarity about finances is essential to avoid misunderstandings.
X-rays and Imaging Records: Copies of all relevant imaging, such as panoramic or 3D scans, that help the new orthodontist assess the patient’s current dental condition.
Clinical Notes: Written notes from the current orthodontist detailing any unique dental circumstances, patient concerns, or specific notes about treatment plans.
Treatment Plan Progress Notes: A record of the progress made on the existing treatment plan, including timelines and modifications made during the course of treatment.
Health History Form: A document detailing the patient’s medical and dental history, which informs the new orthodontist of any health issues that could impact treatment.
Contact Information Update Form: A simple form used to update any necessary contact details for further communication between the old and new providers.
Appointment Summary: A list of past and upcoming appointments to provide the new provider with context regarding the patient’s ongoing treatment schedule.

Each of these documents contributes to a seamless transfer of care and aims to give the new orthodontist a comprehensive view of the patient’s situation. Proper documentation is essential for continuity of care and helps ensure that patients receive the best possible treatment moving forward.

Similar forms

Patient Transfer Form: Similar to the AAO Transfer Form, the Patient Transfer Form is used when a patient transfers from one healthcare provider to another. It includes essential patient information, treatment history, and reasons for transfer, ensuring the new provider is fully informed about the patient's care.
Referral Form: A Referral Form is also comparable because it provides a way to communicate a patient’s needs from one specialist to another. This document outlines relevant medical history and specific reasons for the referral, helping to maintain continuity of care.
Continuity of Care Document: The Continuity of Care Document serves a similar purpose by summarizing a patient’s medical history, ongoing treatments, and care plans. This document emphasizes the importance of keeping all parties in the loop during a patient's care transition, much like the AAO Transfer Form.
Medical Records Release Form: This form allows patients to authorize the release of their medical records to new providers. Just like the AAO Transfer Form, it ensures that the new provider has access to complete patient information, including history and treatment plans, which is crucial for effective treatment.

Dos and Don'ts

Do: Clearly print all information, including the patient's name and current orthodontist details.
Do: Include accurate contact information for the new provider to facilitate communication.
Do: Review the completed form for any errors or omissions before submitting.
Do: Inform the current orthodontist about the transfer request to ensure a smooth process.

Don't: Skip sections of the form, as incomplete information can delay the transfer.
Don't: Use shorthand or abbreviations that may cause confusion.
Don't: Submit the form without obtaining the proper signatures.
Don't: Ignore specific instructions regarding the attached records to be sent with the form.

Misconceptions

When dealing with the Aao Transfer form, there are several common misconceptions that can lead to confusion. Understanding these myths can help patients navigate their orthodontic journey more effectively.

All records are automatically transferred without consent. This is not true. Patients or guardians must authorize the release of records by signing the form.
Transferring orthodontists will start from scratch. While some aspects of treatment may reset, most orthodontists will continue from where the previous provider left off.
The transferring office charges no fees. It's common for there to be fees associated with transferring records, which can vary by provider.
Every orthodontist accepts new patients in the middle of treatment. Some orthodontists may not have the capacity or willingness to take on patients who are already undergoing treatment.
Patients won’t experience changes in treatment fees. Often, transferring can lead to increased costs due to different pricing policies or treatment plans.
Verbal requests for transfer are sufficient. Official written requests on the Aao Transfer form are required to facilitate the transfer of records.
All previous treatment info will be included. Not all treatment records may be included, particularly if they were not documented or requested.
The new provider will know everything about previous treatment. The amount of detail discussed in the form varies; hence, some context may be missing.
Patients can ignore their responsibilities during the transfer. Patients must ensure that their new provider receives all necessary records to continue their treatment effectively.
Once signed, the transfer cannot be reversed. Patient circumstances can change, allowing for a request to revert decisions if necessary.

By clarifying these misconceptions, patients can approach the process of transferring their orthodontic care with greater confidence and understanding.

Key takeaways

Complete all sections accurately. Ensure that the patient’s information—like name, contact details, and treatment history—is filled in completely. This facilitates smoother communication and better continuity of care.
Communicate any concerns effectively. The form includes sections to detail patient concerns and any health history. Providing this information allows the new orthodontist to understand the patient's specific needs.
Clarify financial arrangements. Document all financial details thoroughly. Both the transferring and receiving offices need to understand the patient's payment history and any outstanding balances.
Facilitate records transfer promptly. Ensure that all necessary records, like x-rays and treatment notes, are included to support the new provider in continuing treatment without delay.

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