AAO Transfer Form Patient in Active Treatment 2009-2025 free printable template

Name: AAO Transfer Form Patient in Active Treatment - Fill Online, Printable, Fillable, Blank - pdfFiller
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AAO TRANSFER FORM PATIENT IN ACTIVE TREATMENT Date To From Phone - Patient s name Social Security Birth date Responsible party Home address Fax Age Sex Relationship 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 APPLIANCES Appliance type manufacturer type of bracket metal or non-metal and variations Date bands and/or brackets placed Max Mand Bonding...Agent Current archwire size and type Max Extraoral type and dates initiated Hours requested Intraoral elastics dates initiated size and direction Removable appliance type and dates initiated Cementing Agent PATIENT COOPERATION Oral hygiene Headgear Elastics Appointments Broken appliances Patient s attitude toward treatment Suggestions for patient motivation ACTIVE TX TIME ESTIMATES Original Remaining of active treatment completed ACTIVE TREATMENT RECOMMENDATIONS RETENTION AND THIRD MOLAR...RECOMMENDATIONS ADDITIONAL COMMENTS American Association of Orthodontists 1999 Transfer Active 5/00 Reviewed 09/09 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 TRANSFER OF RECORDS Enter date Dates of our Records Casts Articulator type Cephalograms Tracings Intraoral radiographs...Facial photographs Intraoral photographs Transferring Duplicate Initial Original Progress Check appropriate status of records Record duplicates available upon request at extra charge Records enclosed Yes No Under separate cover Signature Date Orthodontist PATIENT RECORDS RELEASE AUTHORIZATION 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 to release all records of for the purpose of continuation of treatment by another orthodontist. 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.

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Understanding the AAO Transfer Form for Patients in Active Treatment

What is the AAO Transfer Form?

The AAO Transfer Form is a critical document used when a patient needs to transfer their orthodontic care from one provider to another during ongoing treatment. This form streamlines the process, ensuring that all pertinent patient information is communicated effectively between orthodontists. It encompasses patient details, treatment history, and relevant medical information. By facilitating the transfer, the form helps minimize disruptions in the patient's treatment plan.

Key Features of the AAO Transfer Form

The AAO Transfer Form includes sections for essential details such as patient demographics, treatment history, and current orthodontic appliances. Key features involve:

Includes name, date of birth, contact details, and social security number.
Details about the patient's active treatment plan, appliances used, and significant health concerns.
Specifications about the types and dates of dental appliances placed, including archwire sizes.
Information about fees, payments made, and balances due to ensure financial clarity.

When is the AAO Transfer Form Used?

This form is used when a patient requires a change of orthodontic providers for various reasons, such as relocation, a referral, or dissatisfaction with their current treatment. It ensures continuity of care by allowing the new provider to understand the patient's history and current status, enabling them to pick up treatment seamlessly.

Required Information for the AAO Transfer Form

To complete the AAO Transfer Form, several types of information are required. Essential details include:

Full name, address, contact numbers, and social security number.
Details related to ongoing orthodontic treatment, including any appliances currently in use.
A summary of previous treatments, including any complications or significant concerns.
Details about payments made and the outstanding balance to ensure transparent financial transitions.

Best Practices for Completing the AAO Transfer Form

To ensure accuracy and efficiency when filling out the AAO Transfer Form, consider the following best practices:

Ensure that all entries are complete and accurate to avoid delays in treatment transfer.
Use straightforward language when detailing treatment history and current status.
Attach any relevant records that support the information provided to enhance clarity.

Common Issues and Troubleshooting

When completing the AAO Transfer Form, users may encounter challenges. Common issues include missing information or miscommunication between providers. If difficulties arise:

Check for any sections left incomplete and clarify any ambiguities in the treatment history.
Reach out to both the previous and new orthodontists for any additional information required.
If unsure about specific entries, consult office staff for guidance on completing the form correctly.