Table of Contents
The Aao Transfer form serves as a crucial document in the realm of orthodontic care, facilitating the seamless transition of patient records between orthodontic providers. This form is particularly important when a patient is in active treatment and needs to transfer to a new orthodontist, whether due to relocation, personal preference, or other circumstances. It encompasses a variety of essential sections, including patient identification details, treatment history, and specific concerns raised by the patient or their guardians. The form meticulously outlines the treatment plan, progress made, and appliances used, ensuring that the new provider has a comprehensive understanding of the patient's orthodontic journey. Additionally, it addresses financial aspects, highlighting any outstanding balances or payment arrangements that may affect the continuation of care. By detailing the necessary records for transfer, such as radiographs and treatment progress notes, the form aims to eliminate gaps in communication and ensure that the new orthodontist can promptly and effectively resume treatment. Overall, the Aao Transfer form is a vital tool designed to protect patient continuity of care and enhance the overall orthodontic experience.
Document Specifics
| Fact Name | Description |
|---|---|
| Purpose | The AAO Transfer Form is designed to facilitate the transfer of orthodontic records when a patient changes providers during active treatment. |
| Patient Information | The form requires detailed patient information, including the patient's name, birth date, and contact details, to ensure accurate record transfer. |
| Legal Compliance | In many states, the transfer of medical records, including orthodontic records, is governed by laws such as the Health Insurance Portability and Accountability Act (HIPAA) to protect patient privacy. |
| Financial Considerations | The form outlines financial details related to the patient's treatment, indicating potential changes in fees and payment policies upon transfer. |
| Record Availability | It specifies the types of records available for transfer, including casts, x-rays, and treatment progress notes, ensuring comprehensive information for the new provider. |
Similar forms
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Patient Transfer Form: Similar to the AAO Transfer Form, a Patient Transfer Form is used when a patient needs to change healthcare providers. It includes essential details about the patient's medical history, current treatment, and any specific concerns that the new provider should be aware of. Both forms aim to ensure a smooth transition and continuity of care.
- Vehicle Transfer Document: In a manner similar to the AAO Transfer Form, this document is crucial for private sales of vehicles 1972 or older, ensuring the transaction is recorded legally alongside supporting documents, such as bills of sale. For further details, you can visit nytemplates.com/blank-new-york-mv51-template.
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Medical Records Release Form: This document allows patients to authorize the release of their medical records to another provider. Like the AAO Transfer Form, it emphasizes patient consent and includes necessary personal information, ensuring that the new provider has access to all relevant medical history for effective treatment.
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Referral Form: A Referral Form is used when a healthcare provider recommends a patient to another specialist. Similar to the AAO Transfer Form, it contains details about the patient's condition and treatment history, helping the new provider understand the context of the patient's care.
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Continuity of Care Document (CCD): This document provides a summary of a patient's health information, including demographics, medications, and allergies. Like the AAO Transfer Form, the CCD aims to facilitate communication between providers and ensure that the patient's treatment continues seamlessly, even when transferring care.
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
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 |
Initial |
Date ________ |
Progress Date ________ |
Panoramic |
Initial Date ________ |
Progress Date ________ |
|
CBCT |
Initial Date ________ |
Progress Date ________ |
|
Initial |
Date ________ |
Progress Date ________ |
|
files |
|
|
|
Intraoral |
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)
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© American Association of Orthodontists 2014
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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© American Association of Orthodontists 2014
Understanding Aao Transfer
What is the purpose of the AAO Transfer Form?
The AAO Transfer Form is designed to facilitate the transfer of orthodontic records from one provider to another. This ensures that the new orthodontist has all the necessary information about the patient's treatment history, current status, and any specific concerns. The goal is to provide a seamless transition in care, allowing the new provider to continue treatment effectively.
What information is required on the AAO Transfer Form?
The form requires detailed patient information, including the patient's name, date of birth, and contact information. It also asks for treatment history, patient concerns, and a summary of the treatment plan. Additionally, it includes sections for documenting appliances used, patient cooperation, financial details, and recommendations for continued treatment.
How does the transfer process work?
Once the AAO Transfer Form is completed, the current orthodontist will review the information and prepare the necessary records for the new provider. This may include treatment progress notes, radiographs, and any other relevant documentation. The form must be signed by the patient or guardian to authorize the release of these records.
Can a patient transfer during active treatment?
Yes, patients can transfer during active orthodontic treatment. However, it is important to note that the total cost of treatment may increase when transferring to a new provider. Different practices may have varying fee structures, and the new orthodontist will outline any changes in payment policies.
What should patients consider before transferring?
Patients should consider the qualifications and experience of the new orthodontist, as well as their approach to treatment. It is advisable to discuss any concerns with both the current and new providers. Additionally, understanding the potential financial implications is crucial, as costs may vary significantly.
How can patients ensure a smooth transfer?
To ensure a smooth transfer, patients should provide complete and accurate information on the AAO Transfer Form. Communication between the current and new orthodontists is essential. Patients should also follow up to confirm that all records have been received and that the new provider has everything needed to continue treatment without delays.
What if the patient has questions about their treatment after the transfer?
If patients have questions about their treatment after transferring, they should reach out directly to their new orthodontist. Open communication is key to addressing any concerns and ensuring that the treatment plan aligns with the patient's needs and expectations.
Dos and Don'ts
When filling out the AAO Transfer form, it is crucial to ensure accuracy and completeness. Here is a list of things you should and shouldn't do:
- Do fill in all required fields completely, including patient name and contact information.
- Do provide a detailed analysis of the patient's treatment history.
- Do include any significant health concerns or special considerations.
- Do specify the current treatment plan and progress to date.
- Do clearly indicate any appliances used and their status.
- Don't leave any sections blank unless instructed to do so.
- Don't provide vague or unclear descriptions of treatment progress.
- Don't forget to sign and date the form before submission.
- Don't overlook the financial information, as it is essential for the new provider.
- Don't assume that the new provider will know the patient's history without detailed records.
Completing the form accurately will facilitate a smoother transition for the patient and ensure that their ongoing treatment is not interrupted.
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