Record Transfer

Board takeaway

• A useful transfer makes unfinished care and the next step immediately visible.
• Summarize completed, deferred, and ongoing treatment; supply dated imaging, important medical and behavior considerations, outstanding referrals, assessed risks, and recall timing.
• Include clinician contact information so the receiving team can resolve questions.

Identify the patient and care status

• Record recipient, transfer date, patient name/nickname, birth date, gender, parent/legal guardian, and special health care needs.
• Include first encounter, presenting concern, latest examination, and completed/deferred/ongoing treatment status.
• Describe oral hygiene and noteworthy findings: developmental differences, soft-tissue disease, fluorosis, caries with cavitation status, malocclusion, trauma, and habits.
• List radiograph types and dates: bitewing, panoramic, full-mouth, individual-tooth, cephalometric, or other imaging.

Summarize prevention and treatment

• Document fluoride and its latest application date, sealants, prescribed fluoride/chlorhexidine, and dietary advice.
• Summarize eruption/growth monitoring, appliances, retention, and completed occlusal treatment.
• Describe caries burden and interventions: silver diamine fluoride, resin infiltration, pulp treatment, interim restorations, restoration materials/crowns, extractions, and other care.
• Add trauma history with date and explanatory comments.

Communicate ongoing needs

Read the handoff from the receiving clinician’s perspective: what still needs treatment, what affects safe delivery, and when follow-up is due. The form summarizes care; include the relevant records and images through the authorized transfer process.

• Describe cooperation, previous difficulties, ongoing considerations, and nitrous oxide/sedation/general anesthesia or other adjuncts used.
• Record specialty referrals and additional considerations.
• Enter assessed caries and periodontal risk separately, each as low/moderate/high; provide recall interval and next due date.
• Supply dentist name, signature, telephone, and email for clarification.

Common board traps

Answer aloud

What information makes a dental record transfer actionable?

Make remaining care and follow-up clear so the receiving team can continue treatment and contact the transferring clinician about unresolved issues.

• Care status: completed and unresolved treatment.
• Records: dated radiographs and trauma history.
• Care needs: medical and behavior needs; disease risk.
• Next steps: outstanding referrals and recall timing.
• Communication: clinician contact information.