Get Aao Transfer Form

The Aao Transfer Form is a document designed to facilitate the transfer of orthodontic records when a patient changes providers during active treatment. This form captures essential patient information, treatment history, and recommendations for continued care, ensuring a smooth transition between orthodontists. For those needing to fill out the form, please click the button below.

Structure

The Aao Transfer form is a critical document designed for patients undergoing active orthodontic treatment who need to change their orthodontist. This form facilitates the seamless transfer of essential patient information between the current provider and the new provider. Key components include patient identification details, such as name, birth date, and contact information, as well as an analysis of the patient's treatment history and concerns. The form also outlines the treatment plan, progress, and any appliances used during the course of treatment. Furthermore, it addresses patient cooperation and provides estimates of active treatment time remaining. Financial details are included, such as any outstanding balances and payment arrangements, ensuring transparency regarding costs associated with the transfer. Lastly, the form allows for the transfer of relevant records, such as x-rays and treatment progress notes, which are crucial for the new orthodontist to continue care effectively. This comprehensive approach aims to ensure that patients receive uninterrupted treatment while transitioning to a new provider.

Aao Transfer Preview

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 ______________________________

➤ PDF File

Document Data

Fact Name	Details
Purpose of the Form	The AAO Transfer Form is designed to facilitate the transfer of patient records between orthodontic providers during ongoing treatment.
Patient Information	Essential patient details include name, birth date, and contact information, ensuring the new provider has accurate records.
Active Treatment Status	The form requires documentation of the patient's current active treatment status, including progress and estimated remaining time.
Health Concerns	Providers must note any significant health or history concerns that could affect treatment, ensuring continuity of care.
Financial Information	Details about treatment fees, including any unpaid balances and potential changes in payment policies, are crucial for transparency.
Records to be Transferred	The form outlines specific records to be transferred, such as casts, x-rays, and treatment progress, which are vital for the new provider.
Consent Requirement	Patient or guardian consent is necessary for the release of records, ensuring compliance with privacy regulations.
State-Specific Regulations	Different states may have unique laws governing patient record transfers, such as HIPAA regulations and state dental practice acts.

How to Use Aao Transfer

Filling out the AAO Transfer Form is an important step for patients transitioning between orthodontic providers. This form ensures that all necessary information about the patient's treatment is communicated effectively, allowing for a smooth continuation of care. Below are the steps to complete the form accurately.

Enter the date at the top of the form.
Fill in the names and contact information for both the current and new orthodontist, including phone and fax numbers, and email addresses.
Provide the patient’s name, birth date, sex, and Social Security number.
List the responsible party’s name, their relationship to the patient, and the home address, including city, state/province, and zip code.
In the analysis section, include significant history and any concerns related to temporomandibular disorders (TMD).
Document any patient or parent concerns regarding treatment.
Outline the treatment plan, including a chronology of treatment rendered.
Describe the treatment progress in detail, including dates and specific procedures.
For appliances, specify the type, manufacturer, and details about brackets, bonding agents, and current archwire sizes.
Indicate the patient’s cooperation level regarding oral hygiene, headgear, elastics, clear trays, appointments, and any broken appliances.
Estimate the original active treatment time and the remaining time.
Provide recommendations for continued treatment and retention.
Include any additional comments that may be relevant.
Fill in the financial information, indicating whether the account is closed or open-ended, and detail the fees and payment status.
Check the appropriate status of records and indicate if duplicates or records are enclosed or sent separately.
Sign and date the form at the bottom, ensuring the orthodontist's signature is also included.
Complete the request to transfer records section, providing the necessary authorizations and signatures from the patient or guardian.

Key Facts about Aao Transfer

What is the Aao Transfer form?

The Aao Transfer form is a document used when a patient needs to transfer their orthodontic treatment from one provider to another. It ensures that all relevant information about the patient's treatment history, current status, and financial obligations is accurately communicated to the new orthodontist. This helps facilitate a smooth transition and continuity of care.

Why is it important to fill out the Aao Transfer form?

Completing the Aao Transfer form is crucial for several reasons. First, it provides the new orthodontist with essential information regarding the patient's treatment history and current needs. Second, it helps avoid any gaps in treatment, which could lead to complications. Lastly, it ensures that all financial matters are clear, preventing misunderstandings regarding fees and payment policies.

What information is required on the Aao Transfer form?

The form requires detailed information, including the patient's personal details, treatment history, current appliances, and any specific concerns the patient or their guardians may have. Additionally, it includes sections for financial information and recommendations for continued treatment. All this data helps the new orthodontist understand the patient's situation fully.

Who needs to sign the Aao Transfer form?

The Aao Transfer form must be signed by the patient or their guardian. This signature authorizes the current orthodontist to release the patient's records to the new provider. It is important that the person signing has a legal relationship to the patient to ensure compliance with privacy regulations.

Can I transfer my records if I have an outstanding balance?

Yes, you can still transfer your records even if you have an outstanding balance with your current orthodontist. However, it is essential to understand that transferring may lead to changes in your financial obligations with the new provider. It is advisable to discuss any outstanding payments with your current orthodontist before initiating the transfer.

What happens to my treatment plan during the transfer?

Your treatment plan will be reviewed by the new orthodontist once they receive your records. They may choose to continue with the existing plan or make adjustments based on their assessment of your orthodontic needs. Open communication between you and both orthodontists will be vital to ensure a successful continuation of your treatment.

Will transferring my treatment affect my costs?

Transferring your orthodontic treatment may lead to changes in costs. Different orthodontists have varying fee structures, and additional charges may apply for the continuation of care. It is important to discuss these potential changes with both your current and new orthodontist to understand what to expect financially.

How long does it take to process the Aao Transfer form?

The processing time for the Aao Transfer form can vary depending on the current orthodontist's office policies and workload. Typically, once the form is submitted, the records should be transferred promptly to ensure continuity of care. It is advisable to follow up with both offices to confirm that the transfer is completed smoothly.

Common mistakes

Completing the AAO Transfer form accurately is essential for a smooth transition of orthodontic care. However, several common mistakes can hinder this process. One frequent error occurs when individuals neglect to provide the patient's full name as it appears on their records. This detail is crucial for ensuring that the new provider can easily identify the patient and access their records without confusion.

Another mistake involves omitting or incorrectly filling out the date of birth. This information helps verify the patient's identity and is often required for insurance purposes. An incorrect birth date can lead to delays in treatment or complications with insurance claims.

People often overlook the contact information section, particularly the phone number and email address. Providing accurate and current contact details is vital for communication between the transferring and receiving orthodontists. Missing or incorrect contact information can result in important updates being missed.

Additionally, some individuals fail to adequately describe the treatment progress. This section should include a detailed chronology of treatment rendered. Without this information, the new provider may not fully understand the patient's history, which could affect their ability to continue treatment effectively.

Another common error is related to the financial information. It is crucial to provide accurate details about any unpaid balances or fees associated with the treatment. Inaccuracies in this section can lead to misunderstandings regarding payment obligations and may complicate the transfer process.

Patients sometimes forget to indicate the status of records being transferred. Whether records are enclosed, sent under separate cover, or need to be duplicated should be clearly marked. This clarity is important for ensuring that the new provider receives all necessary documentation without delays.

Furthermore, many people do not take the time to address special health or history concerns. This section is critical for the new provider to understand any unique medical issues that may affect treatment. Omitting this information could lead to complications or inappropriate treatment decisions.

Finally, some individuals neglect to sign and date the form. A missing signature can render the transfer request invalid, causing unnecessary delays in the patient's care. Ensuring all sections are complete and properly signed is vital for a seamless transition.

Documents used along the form

The AAO Transfer form is a crucial document used in the process of transferring a patient’s orthodontic records from one provider to another. Along with this form, there are several other documents that may be necessary to ensure a smooth transition and continuity of care. Below is a list of commonly used forms and documents that accompany the AAO Transfer form.

Patient Information Form: This document collects essential details about the patient, including contact information, medical history, and insurance details. It helps the new provider understand the patient’s background.
Consent for Treatment: This form is required to obtain permission from the patient or guardian for the new orthodontist to proceed with treatment. It ensures that all parties are informed and agree to the treatment plan.
Financial Agreement: This document outlines the financial arrangements between the patient and the orthodontic practice. It includes payment plans, fees, and any outstanding balances that need to be addressed.
Medical History Form: This form details the patient's medical background, including allergies, medications, and previous surgeries. It is vital for the new provider to tailor treatment safely.
Insurance Authorization Form: This document allows the new orthodontist to communicate with the patient’s insurance company regarding coverage and benefits. It helps in managing financial aspects of treatment.
Records Release Authorization: This form grants permission for the current provider to release the patient’s records to the new provider. It is a critical step in ensuring that the transfer is legitimate.
Appointment History: This document summarizes the patient’s past appointments, including treatment dates and procedures performed. It provides the new provider with context for ongoing care.
Progress Notes: These notes contain detailed information about the patient's treatment progress, including any challenges faced and modifications made to the treatment plan.
Radiographs and Imaging Reports: This includes any X-rays or imaging studies taken during treatment. These records are essential for the new orthodontist to assess the patient’s current condition.
Patient Cooperation Report: This document evaluates the patient’s adherence to treatment protocols, such as wearing appliances as prescribed. It can inform the new provider about potential challenges in treatment compliance.

Each of these documents plays a significant role in ensuring that the transfer of care is seamless and that the new orthodontist has all the necessary information to provide effective treatment. Proper documentation not only facilitates communication but also enhances patient safety and satisfaction during the transition.

Similar forms

Patient Referral Form: Similar to the AAO Transfer form, a patient referral form is used to transfer a patient’s care from one healthcare provider to another. It includes patient information, treatment history, and the reason for the referral, ensuring continuity of care.
Medical History Form: This document captures a patient’s medical background and current health status. Like the AAO Transfer form, it gathers essential information that helps new providers understand the patient's health and treatment needs.
Consent for Treatment Form: This form is necessary for obtaining patient consent before treatment begins. It shares similarities with the AAO Transfer form in that it outlines treatment plans and potential risks, ensuring patients are informed before proceeding.
Insurance Verification Form: This document is used to confirm a patient’s insurance coverage and benefits. Like the AAO Transfer form, it includes financial details and obligations, which are crucial for both the patient and the new provider.
Patient Information Update Form: This form is used to update patient records, including contact information and treatment preferences. It parallels the AAO Transfer form by ensuring that all relevant patient details are current and accessible to the new provider.

Dos and Don'ts

When filling out the AAO Transfer Form, there are important guidelines to follow. Below is a list of things you should and shouldn't do to ensure a smooth process.

Do provide accurate and complete information.
Do ensure that all required signatures are obtained.
Don't leave any sections blank unless instructed otherwise.
Don't forget to double-check for any spelling or numerical errors.

Misconceptions

Misconception 1: The Aao Transfer form is only for patients who are unhappy with their current orthodontist.

This form is not solely for those seeking a change due to dissatisfaction. Patients may need to transfer for various reasons, such as relocation or changes in insurance coverage.

Misconception 2: Completing the Aao Transfer form is a complicated process.

While it may seem daunting, the form is designed to be straightforward. Most sections require basic information about the patient and their treatment history, making it manageable for anyone.

Misconception 3: The Aao Transfer form guarantees that my new orthodontist will accept me.

Submitting the form does not guarantee acceptance. It's important to confirm with the new orthodontist beforehand to ensure they can accommodate your treatment needs.

Misconception 4: Transferring records will delay my treatment significantly.

When done promptly, transferring records can actually expedite the continuation of treatment. The new orthodontist will have the necessary information to pick up where your previous provider left off.

Misconception 5: My treatment fees will remain the same after transferring.

Fees can vary between providers. The form includes a notice indicating that treatment costs may increase after a transfer, so it's wise to discuss financial aspects with your new orthodontist.

Misconception 6: I don’t need to inform my current orthodontist about the transfer.

It’s courteous and often necessary to inform your current orthodontist about your decision to transfer. They can help facilitate the process and ensure a smooth transition for your treatment.

Key takeaways

Here are key takeaways for filling out and using the AAO Transfer form:

The form is designed for patients currently undergoing orthodontic treatment.
Clearly fill in the patient’s personal information, including name, birth date, and contact details.
Provide a comprehensive analysis of the patient's dental history and treatment progress.
Document any specific concerns from the patient or parent regarding treatment.
Detail the treatment plan, including the chronology of procedures performed.
Include information about appliances used, such as types and manufacturers.
Assess patient cooperation with treatment, noting oral hygiene and appointment attendance.
Be aware that transferring may lead to increased treatment costs.
Indicate the status of records being transferred, including any duplicates.
Ensure that both the current and new orthodontists are properly identified for the transfer.