Aao Orthodontic Transfer Form Details

Aao Transfer Form is a new website that allows anyone to start an online business. We provide all the necessary tools for you to be able to run your own business without having any prior experience. All you have to do is register and select your desired product or service which will then take you through the signup process. The only thing we require from our customers is their email address, password, and name of their company so they can identify themselves as unique individuals on our site.

Here is some data that may be useful in case you are seeking to determine just how long it'll require you to fill out aao transfer form and just how many PDF pages it includes.

QuestionAnswer
Form NameAao Transfer Form
Form Length3 pages
Fillable?Yes
Fillable fields87
Avg. time to fill out18 min 13 sec
Other namesaao form, aao transfer form fillable, aao orthodontic transfer form, aao transfer

Form Preview Example







AAO TRANSFER FORM

PATIENT IN ACTIVE TREATMENT

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone (

)

 

 

-

 

 

 

 

 

 

Fax (

)

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Patient's name

 

 

 

 

 

 

Birth date

 

 

 

 

 

 

Age

 

 

 

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)

APPLIANCES

Appliance (type, manufacturer, type of bracket–metal or non-metal, and variations)

 

 

 

Date bands and/or brackets placed: Max

 

 

 

 

Mand

 

 

 

 

Bonding Agent

 

 

 

Cementing Agent

Current archwire size and type: Max

 

 

 

 

Mand

 

 

 

 

 

 

 

 

 

 

 

 

 

Extraoral type and dates initiated

 

 

Hours requested

 

 

 

 

 

 

 

 

 

 

 

 

Intraoral elastics, dates initiated, size and direction

 

 

Hours requested

 

 

 

 

Removable appliance type and dates initiated

 

 

 

 

 

Hours requested

 

 

 

 

 

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

1

©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 Yes No

Yes

No

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

(Orthodontist's Name)

__________________________________ for the purpose of continuation of treatment by another orthodontist.

(Patient's Name)

Signature: __________________________________________________________Date_______________________

(Patient or Guardian)

2

© American Association of Orthodontists 1999

Transfer – Active 5/00

Reviewed 09/09

Print Name ________________________________________

Relationship to Patient _______________________________

3

©American Association of Orthodontists 1999 Transfer – Active 5/00 Reviewed 09/09

How to Edit Aao Transfer Form

The filling in the aao transfer form fillable is quite quick. Our experts made sure our software is easy to understand and helps complete virtually any document in a short time. Below are several steps you'll want to follow:

Step 1: To begin with, click the orange "Get form now" button.

Step 2: Now you are going to be within the file edit page. It's possible to add, enhance, highlight, check, cross, insert or erase fields or phrases.

Provide the data demanded by the system to fill in the file.

example of fields in aao forms

You need to complete the ANALYSIS (Including significant, APPLIANCES, Appliance (type, Date bands and/or brackets placed:, Mand, Bonding Agent, Cementing Agent, Current archwire size and type: Max, Mand, Extraoral type and dates initiated, Hours requested, Intraoral elastics, Hours requested, Removable appliance type and dates, Hours requested, PATIENT COOPERATION, Oral hygiene, Headgear, Elastics, Appointments, Broken appliances, and Patient's attitude toward treatment field with the requested information.

part 2 to completing aao forms

Type in all details you may need within the section Patient's attitude toward treatment, Suggestions for patient motivation, ACTIVE TX TIME ESTIMATES Original, Remaining, % of active treatment completed, ACTIVE TREATMENT RECOMMENDATIONS, © American Association of, and Transfer – Active 5/00 Reviewed.

stage 3 to finishing aao forms

Please record the rights and responsibilities of the parties in the 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, Balance of original quoted fee not, or overpaid at transfer, TRANSFER OF RECORDS (Enter date), Dates of our: Records, Casts, Articulator type, Cephalograms, Tracings, Intraoral radiographs, and Facial photographs field.

step 4 to completing aao forms

Finalize by analyzing the following fields and typing in the pertinent details: (Orthodontist), Signature:, PATIENT RECORDS RELEASE, and When a patient moves.

Completing aao forms stage 5

Step 3: Hit the Done button to save your form. Now it is obtainable for transfer to your gadget.

Step 4: To protect yourself from any headaches in the long run, you should get up to several duplicates of the form.

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .