The AAO Transfer Form is a crucial document designed to ensure the seamless transfer of a patient undergoing orthodontic treatment from one provider to another. It encompasses comprehensive information about the patient's treatment plan, progress, and the orthodontic appliances used, alongside any special health concerns that the new provider needs to be aware of. Facilitating a well-coordinated transition, this form plays an essential role in maintaining continuity of care, thereby safeguarding the patient's orthodontic treatment outcomes.
Within the realm of orthodontic care, the process of transferring a patient from one orthodontist to another during ongoing treatment involves a detailed protocol to ensure continuity and quality of care. This process is encapsulated in the AAO Transfer Form, a comprehensive document designed by the American Association of Orthodontists in 2014. The form records crucial information including the patient's active treatment status, personal and contact information, a thorough treatment analysis that traces the treatment progress, patient concerns, special health history, and outlines the treatment plan including appliances used. It also assesses patient cooperation, estimates the active treatment time remaining, and provides recommendations for continued treatment and retention strategies. Moreover, it addresses the financial aspects related to the transfer, alerting the patient to varying treatment fees and policy changes. Critical for both the continuity of care and legal compliance, the form necessitates detailed documentation of orthodontic records - including casts, cephalometric images, photographs, and radiographs - and stipulates the procedure for their transfer. By facilitating this information flow, the AAO Transfer Form plays a pivotal role in ensuring seamless treatment continuation, while safeguarding the interests of both the patient and the orthodontic professionals involved.
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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When the time comes to transfer an orthodontic patient from one provider to another, the AAO Transfer Form serves an important role in ensuring a seamless continuation of care. This document contains all the necessary details about the patient's treatment up to that point, including their history, appliances used, progress, and any special considerations. Completing this form accurately and comprehensively facilitates the new provider's understanding and allows them to pick up where the previous orthodontist left off.
After completing the AAO Transfer Form, it's essential to review it for accuracy and completeness before sending it to the new provider. This document plays a crucial role in ensuring the patient's orthodontic care is continuous, aligned with their treatment plan, and adjusts smoothly to their new orthodontic practice. Timeliness and thoroughness in completing and sending this form are key to facilitating a smooth transition for the patient.
What is the purpose of an AAO Transfer Form?
The AAO Transfer Form is designed for use when an orthodontic patient needs to change their orthodontist during active treatment. This might happen due to a move or other personal reasons. The form facilitates the smooth transfer of a patient's records to the new provider, ensuring continuity of care. It includes the patient's treatment details, such as the analysis, treatment plan, progress, and any special concerns or health history. Additionally, it provides a section for the patient or guardian to authorize the release of records to the new orthodontic provider.
What information is included in the treatment details of the AAO Transfer Form?
The treatment details section of the AAO Transfer Form provides comprehensive information about the patient's orthodontic treatment. It includes an analysis of the patient's condition, details about the treatment plan and its progress, types of appliances used, and patient cooperation. Information such as the type of brackets, current archwire size, and any extraoral or removable appliances are also detailed. This ensures the receiving orthodontist is fully aware of what has been done and what needs to be completed.
How does the AAO Transfer Form handle financial information?
The form includes specific sections to outline the financial aspects of the patient's treatment. It lists the fees for active treatment, any additional charges, payment terms, and third-party payments. Information about the total charges incurred before the transfer, the amount paid, and any outstanding balance is provided. The form also explains that orthodontic treatment fees can vary widely, and transferring patients should expect potential changes in fees and payment policies at the new practice.
What happens to my records when changing orthodontists, according to the AAO Transfer Form?
Your records, which may include casts, cephalometric and panoramic x-rays, CBCT images, intra-oral scans, and photographs, are critical for continuing your treatment. The form has provisions for transferring these records. You or your guardian must authorize the release of these records to the new orthodontist. The records can be sent directly, under separate cover, or duplicates provided upon request, possibly for an additional charge. This ensures the new provider has access to all necessary documentation for a seamless transition in your orthodontic care.
Filling out the AAO Transfer Form is a critical step during the transfer of an orthodontic patient from one provider to another. However, several common mistakes can complicate this process. Recognizing and avoiding these errors ensures a smoother transition for the patient and all involved parties.
One significant mistake is not fully completing the form. Leaving sections blank, such as the patient’s birth date, social security number, or treatment progress, can result in delays. Every piece of information on the form serves a purpose, ensuring the receiving provider has a comprehensive understanding of the patient’s condition and treatment plan.
Incorrect contact information is another common error. This includes the phone numbers and email addresses for the transferring and receiving orthodontists. Accurate contact information is vital for clear communication between the two offices. Any inaccuracies can lead to misunderstandings or delays in the transfer process.
Failure to clearly outline the treatment progress and remaining treatment needs can also pose problems. This information helps the new provider understand what has been accomplished and what is still needed to complete the patient's treatment plan effectively. Without this, the patient could face setbacks or unnecessary repeat procedures.
Another mistake involves the handling of financial information. Not accurately documenting the financial status of the patient's account, including fees already paid and the balance owed, can lead to confusion and disputes over payment. This is particularly important because, as the form notes, treatment fees can vary widely, and transferring patients should anticipate possible changes in costs.
Not specifying the current status of records can complicate the transfer. The form provides options to indicate if records are enclosed, sent under separate cover, or if duplicates are sent upon request. Overlooking this step can hinder the new provider's ability to access vital treatment information, delaying the patient's progress.
Finally, not obtaining or incorrectly documenting the necessary signatures for the authorization of record release is a critical oversight. This legal step ensures the patient or guardian consents to the transfer of sensitive information. Failing to do this correctly can violate privacy regulations and further delay the transfer process.
When managing the process of orthodontic treatment, specifically during a transfer from one provider to another, several important documents accompany the AAO Transfer Form to ensure a smooth and well-informed transition. These documents play vital roles in conveying the necessary information about the patient's treatment plan, progress, and financial details. Understanding each document's key functions can significantly aid both patients and practitioners through the transfer process.
Equipped with these documents, both the patient and the new orthodontic provider can ensure a seamless transition, sustaining the progress towards achieving the desired treatment outcomes. It's essential for patients to also actively participate in this process by providing thorough and accurate information in each document, facilitating effective communication and continuity of care.
Medical Release Form: Similar to the AAO Transfer Form, a Medical Release Form is used for sharing patient’s health information between healthcare providers. Both forms require patient or guardian consent to transfer confidential medical records and outline the type of information being transferred, such as treatment plans, history, and progress notes.
Referral Form: This document parallels the AAO Transfer Form in its function to facilitate the continuation of care by another specialist. Referral Forms include information on the patient's condition, the reason for the referral, and any already performed treatments, mirroring the AAO form's inclusion of analysis, patient concerns, and treatment progress.
Consent to Treat Form: Although used primarily to gain permission to start treatment, this form shares similarities with the AAO Transfer Form by necessitating patient or guardian signatures. It emphasizes the importance of informed consent and sharing information between parties for the purpose of treatment, which includes outlining potential treatment plans, exactly as the AAO form does for the transfer scenarios.
Health Information Privacy Authorization Form: Similar to the segment in the AAO Transfer Form regarding the release and transfer of records, this form is critical for complying with privacy laws and regulations, specifically HIPAA in the United States. Both documents ensure that patient information is shared securely and with explicit consent from the patient or their guardian, detailing the extent and nature of the information being shared.
When it comes to filling out an AAO Transfer Form, the process must be approached with attention to detail and clarity to ensure a smooth transition of care for patients undergoing orthodontic treatment. Here are some dos and don'ts to keep in mind:
By following these guidelines, the process of transferring orthodontic care can be made more efficient and transparent for all parties involved, ultimately contributing to the continued success of the patient's treatment.
When it comes to transferring orthodontic records and treatment plans, there are several misconceptions about the AAO Transfer Form that need to be clarified. Understanding these key points can ensure a smooth transition for both the patient and the orthodontic practices involved.
Some people assume that transferring orthodontic records involves complex paperwork. However, the AAO Transfer Form is designed for simplicity and clarity. It requests basic information such as patient details, treatment analysis, treatment plan, and progress, in addition to identifying the records available for transfer. This straightforward approach ensures that the important information is communicated clearly between orthodontists.
A common misunderstanding is that orthodontic treatment fees remain the same irrespective of where the treatment is continued. The AAO Transfer Form explicitly mentions that fees can vary widely and that transferring patients might see an increase in their total treatment cost. This variance accounts for differences in practice costs, regional cost living adjustments, and individual treatment complexities.
While it's logical to assume that transferring to a new provider might cause delays, this is not always the case. The AAO Transfer Form facilitates the efficient transfer of comprehensive treatment details and history, enabling the new orthodontist to pick up where the previous one left off with minimal delay. Efficient communication and transfer of records are key to maintaining treatment momentum.
Another misconception is overlooking the importance of patient cooperation history and the details of previously used appliances in framing the new treatment plan. The AAO Transfer Form includes sections for patient cooperation and appliances for this very reason. Understanding a patient’s compliance history and the appliances already in use allows the new orthodontist to tailor the continuing treatment plan effectively.
Correcting these misconceptions is essential not just for a seamless transition during the transfer process but for setting appropriate expectations for the patient and the receiving orthodontist. The AAO Transfer Form plays a critical role in ensuring the continued success of orthodontic treatment after a transfer.
When it comes to transferring orthodontic treatment, clarity, completeness, and consent are pivotal. The AAO Transfer Form serves as an essential document designed to ensure a seamless transition for patients in active treatment. Here are five key takeaways about filling out and using this form:
Filling out and using the AAO Transfer Form with attention to detail and comprehensive information ensures that patients receive continuous, high-quality orthodontic care even when a change in providers is necessary. It's not just about transferring a patient from one orthodontist to another; it's about ensuring the continuity of care and treatment outcomes that align with the patient's needs and expectations.
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