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Fill Out a Valid Aao Transfer Form

The Aao Transfer Form is a crucial document designed for patients undergoing active orthodontic treatment who need to transfer their care to a new provider. This form ensures that all relevant medical and treatment history is communicated effectively between orthodontists, facilitating a smooth transition for the patient. If you need to fill out this form, please click the button below.

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Structure

When a patient finds themselves in the midst of orthodontic treatment and needs to switch providers, the Aao Transfer form plays a crucial role in ensuring a smooth transition. This form serves as a comprehensive document that captures essential patient information, including personal details, treatment history, and specific concerns related to the ongoing care. It outlines the patient's current treatment plan, progress made, and any appliances used, such as fixed or removable devices. Additionally, it highlights the patient's cooperation and attitude towards treatment, which can be vital for the new provider to understand. Financial considerations are also addressed, detailing any outstanding fees and potential changes in payment policies that may arise due to the transfer. Furthermore, the form facilitates the transfer of vital records, ensuring that the new orthodontist has access to all necessary documentation to continue treatment effectively. By streamlining this process, the Aao Transfer form not only aids in maintaining continuity of care but also helps patients navigate the complexities of orthodontic transitions with greater ease.

Common mistakes

Inaccurate Patient Information: Failing to provide correct details such as the patient's name, birth date, or Social Security number can lead to delays in processing the transfer.
Missing Contact Information: Omitting phone numbers, email addresses, or fax numbers can hinder communication between the current and new orthodontist.
Incomplete Treatment History: Not including a comprehensive treatment plan or significant history may leave the new provider without essential context for ongoing care.
Neglecting Patient Concerns: Failing to document specific patient or parent concerns regarding treatment can result in misunderstandings about the patient's needs.
Omitting Financial Details: Leaving out information about fees, payment status, or unpaid balances can complicate financial arrangements for the new provider.
Ignoring Required Signatures: Not obtaining necessary signatures from the patient or guardian can render the transfer form invalid.
Failure to Specify Record Status: Not indicating whether records are enclosed or sent separately can create confusion regarding what information has been transferred.
Inadequate Documentation of Appliances: Not detailing the types and status of appliances used can lead to improper continuation of treatment.
Not Updating Treatment Progress: Failing to provide current progress notes can mislead the new provider about the patient's treatment status and needs.

Preview - Aao Transfer Form

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 ______________________________

Other PDF Templates

Da 7666 - This form is used to capture data relevant to military personnel.

Notarized Letter of Consent - Check Royal Caribbean's website for any additional documents required alongside the form.

In addition to being a vital record of the transaction, obtaining a copy of the document in pdf can help ensure both parties have the necessary paperwork for their records, making the process of ownership transfer even smoother and more transparent.

Da Form 1380 May 2019 - Clear guidelines are provided to assist in filling out DA Form 1380 completely and accurately.

Documents used along the form

When transferring orthodontic care, several important documents accompany the AAO Transfer Form. These documents ensure a smooth transition between providers and maintain continuity in the patient's treatment. Below are some commonly used forms that facilitate this process.

Patient Consent Form: This document is essential for obtaining permission from the patient or their guardian to share medical records and treatment information with the new orthodontist. It ensures that the transfer complies with privacy regulations and respects the patient's rights.
Financial Agreement: This form outlines the financial arrangements between the patient and the transferring orthodontist. It details any outstanding balances, payment terms, and potential changes in fees due to the transfer. Clarity in this document helps avoid misunderstandings about costs.
Mobile Home Bill of Sale: A legal document that facilitates the transfer of ownership of a mobile home, outlining essential details such as the buyer's and seller's information, the mobile home's specifications, and the sale price. It's crucial for ensuring a smooth transaction and protecting both parties' interests, and you can find a template here: Mobile Home Bill of Sale.
Treatment Summary Report: This report provides a comprehensive overview of the patient's treatment history, including previous procedures, progress made, and future treatment plans. It allows the new orthodontist to quickly understand the patient's case and make informed decisions moving forward.
Record Release Authorization: This form is necessary for the transferring orthodontist to release the patient's records to the new provider. It includes the patient's information and specifies what records are being transferred, ensuring that all relevant data is shared for continued care.

Each of these documents plays a crucial role in the transfer process. By ensuring all necessary forms are completed accurately, patients can experience a seamless transition to their new orthodontic provider. Prompt action in gathering and submitting these documents can significantly impact the continuity and effectiveness of ongoing treatment.

Similar forms

The AAO Transfer Form is similar to a Patient Release Form. Both documents facilitate the transfer of patient information from one healthcare provider to another. The Patient Release Form typically includes patient identification details, a statement of consent for the release of medical records, and the signatures of the patient or guardian. This ensures that the receiving provider can access necessary medical history and treatment plans, much like the AAO Transfer Form does for orthodontic cases.

Another comparable document is the Medical Records Request Form. This form is used when a patient requests their medical records from a healthcare provider. It usually requires the patient's personal information, details about the records being requested, and a signature for authorization. Similar to the AAO Transfer Form, it ensures that all relevant medical history is available for continued care by a new provider.

The Referral Form also shares similarities with the AAO Transfer Form. A Referral Form is used when a healthcare provider refers a patient to a specialist. It contains information about the patient's condition, treatment history, and reasons for the referral. Like the AAO Transfer Form, it aims to provide the new provider with comprehensive information to ensure continuity of care.

The Continuity of Care Document (CCD) is another relevant document. This electronic document summarizes a patient's health information and treatment history, making it easier for new providers to understand the patient's medical background. The CCD, like the AAO Transfer Form, emphasizes the importance of sharing detailed treatment plans and medical history for effective ongoing care.

The Ohio Motor Vehicle Bill of Sale form is essential for documenting vehicle transactions within the state, ensuring clarity between buyers and sellers. Not only does it provide legal proof of ownership transfer, but it is also a critical element for registering and titling the vehicle. For those looking to efficiently manage the purchase or sale of a vehicle, comprehensive resources such as https://autobillofsaleform.com/ohio-motor-vehicle-bill-of-sale-form can be incredibly helpful.

The Treatment Summary is also akin to the AAO Transfer Form. This document outlines the care a patient has received, including details about diagnoses, treatments, and progress. It serves as a comprehensive overview for the new provider, similar to the detailed treatment progress and plans included in the AAO Transfer Form.

Lastly, the Authorization for Release of Information form is comparable. This document allows patients to authorize the sharing of their health information with another provider. It requires patient identification and consent, ensuring that the new provider can access necessary information. This aligns closely with the purpose of the AAO Transfer Form, which seeks to facilitate the transfer of vital orthodontic records for continued treatment.

Dos and Don'ts

Do's

Ensure all fields are filled out completely and accurately.
Provide current contact information for both the transferring and receiving orthodontists.
Clearly state any special health or history concerns related to the patient.
Include a detailed treatment plan and progress notes.
Check the appropriate status of records before submitting the form.
Obtain the necessary signatures from both the orthodontist and the patient or guardian.

Don'ts

Do not leave any required fields blank.
Avoid using abbreviations or jargon that may confuse the receiving orthodontist.
Do not forget to mention any appliances currently in use.
Refrain from providing outdated contact information.
Do not skip the section on patient cooperation and attitude toward treatment.
Do not assume the receiving office knows the patient's history; provide all relevant details.

Key takeaways

When filling out and using the AAO Transfer Form, consider the following key takeaways:

Complete All Sections: Ensure that every section of the form is filled out accurately. This includes patient information, treatment history, and financial details.
Communicate Concerns: Clearly outline any patient or parent concerns regarding treatment. This helps the new orthodontist understand the patient's needs better.
Document Treatment Progress: Include a detailed account of the treatment plan and progress made. This information is crucial for the new provider to continue care effectively.
Understand Financial Implications: Be aware that transferring orthodontic care may lead to changes in fees and payment policies. Patients should expect potential increases in total treatment costs.

How to Use Aao Transfer

Completing the AAO Transfer Form is an important step when transferring orthodontic care. This form helps ensure that all relevant patient information is communicated to the new provider, facilitating a smooth transition in treatment.

Enter the date at the top of the form.
Fill in the name and contact details of the new provider, including phone, fax, and email.
Provide the current provider's name and contact details, including phone and fax.
Complete the patient's personal information, including their name, birth date, sex, and social security number.
List the responsible party's name and their relationship to the patient.
Fill in the home address, city, state/province, and zip code of the responsible party.
Document the patient's significant history and any concerns regarding treatment in the analysis section.
Detail any special health or history concerns related to the patient.
Outline the treatment plan, including a chronology of treatment rendered.
Summarize the treatment progress, including a chronology of treatment rendered.
Specify details about any appliances used, including type, manufacturer, and dates of placement.
Document patient cooperation with oral hygiene, headgear, elastics, clear trays, and appointments.
Estimate the active treatment time, including original and remaining time.
Provide recommendations for continued treatment and retention.
Add any additional comments relevant to the patient's treatment.
Complete the financial section, detailing the status of payments and any outstanding balances.
Indicate which records are available for transfer and check the appropriate status of records.
Sign and date the form at the bottom, ensuring that the orthodontist's signature is included.
Complete the request to transfer records section, providing the necessary signatures and names.