A. Student Affairs

1. Additional Externships Beyond the Fourth Year Service Learning Experiences Policy

Subject: I. Academic – A. Student Affairs

Department: Dental Public Health

NOTE: Additional Externship beyond the Fourth Year Service Learning Experiences see Dr. Swank and Dr. Manski

Origination Date: September 16, 2015 Revised 2/3/16, 5/25/16

Purpose: Defines procedures and steps necessary for students to participate in an externship experience beyond the required Fourth Year Service Learning Externship.

Policy and/or Procedure:

The Fourth Year Service Learning Externship is a three week clinical rotation that provides students with the opportunity to experience dental practice in a setting outside of the dental school. This applies to all fourth year dental students. A link to this policy can also be found here: Additional Externships beyond the Fourth Year Service Learning Experiences (PDF)

Additional Externships beyond the Fourth Year Service Learning Experiences

Students wishing to participate in externships service learning experiences that fall outside of the required, year 4 service learning experience should adhere to the following protocol to obtain permission from the Dental School. The Dental School wants to support students in these endeavors, when there is no conflict with other academic or clinical responsibilities, and when students make the necessary advance arrangements and secure appropriate authorization in advance. These arrangements and authorizations require coordination with several different entities within the Dental School, and are the responsibility of the student seeking the opportunity. The student should:

Submit a written request to Dr. Patricia Meehan, Associate Dean for Academic Affairs. This request should include the dates that the student is proposing for the experience, the site, and the specific activities that the student wishes to undertake. If the student will be missing any regularly scheduled academic assignments, or clinical activities those should be delineated, and the strategies for addressing those responsibilities should be outlined. If clinical activities will be affected, the student will need the approval of their GP Director and Dr. Louis DePaola, Assistant Dean of Clinical Affairs. Dr. Meehan will make the decision regarding whether the student’s absence can be approved.
The student should consult with Dr. Scott Swank, Externship Program Coordinator, to determine whether the Dental School has a current Affiliation Agreement with the proposed site. Affiliation Agreements are required in order for the Dental School’s liability insurance carrier to cover the student’s activities at the site.
If there is no current Affiliation Agreement with the site:
1. The student may request that an institutional Affiliation Agreement be established. This request must be submitted in writing to Dr. Scott Swank, Externship Program Coordinator. Institutional Affiliation Agreements generally take two to three months to complete.
2. If an institutional Affiliation Agreement cannot be established, then it will be the student’s responsibility to obtain their own liability insurance.
The extramural site documents requiring signature by the Dental School will be signed by Dr. Manski and Dr. DePaola, Assistant Dean of Clinical Affairs.

SAMPLE LETTER TO EXTRAMURAL SITE:

Dear _____:

I am writing regarding an externship for one of our students ____(name)____ who wants to do an externship at your (location name and Department).

The externship has not yet been scheduled.

I have attached the Agreement Template that we normally use for our student externships. Please let me know if this would be an acceptable Agreement for ______________. If it is not, please let me know what would need to be changed in the Template for it to be acceptable and send it back to me to review.

If you are not the correct person to contact regarding this, please advise me who would be the person I should contact.

Thank you for your assistance.

Sincerely,

Affiliation Agreement Policy

Subject: I. Academic – A. Student Affairs

Effective Date: 09/01/2015

Reviewed and/or Revised: 09/01/2017

Clinical Affairs’ Affiliation Agreements:

The Affiliation Agreement Template is to be used for all Affiliation Agreements. Allow 2-3 months when processing new and/or renewed Agreements. The 2-3 months’ time frame allows appropriate time for review and to make changes if necessary before the Agreements can be signed and/or approved.

An Affiliation Agreement needs to be reviewed by the originating Faculty member. The Faculty member will then have 3 originals made and sign the 3 originals. The Affiliation Agreement is sent electronically in a Word Document to the Director of Medical Credentialing and Quality Assurance to be reviewed. If appropriate, the Director of Medical Credentialing and Quality Assurance will send the Agreement to UMB Legal for review.

After the Director of Medical Credentialing and Quality Assurance has reviewed the Agreement, the Affiliation Agreement is sent back to the Faculty member with any edits or comments if applicable. The Faculty provider prints 3 originals of the Agreement and signs the Agreement as originator. The Faculty provider will send the 3 originals to the Affiliate to obtain the signature and/or approval of the Affiliate.

If the Affiliate wants any changes made, they need to send them to the Faculty member who will send them to the Director of Medical Credentialing and Quality Assurance to determine if the changes can be made. If no changes to be made, the Affiliate would return the 3 signed originals to the Faculty member who will forward them to the Director of Medical Credentialing and Quality Assurance for review and obtaining Assistant Dean of Clinic Affairs’ signature/ approval.

The Director of Medical Credentialing and Quality Assurance will keep one of the originals for SOD files, and return the other 2 originals to the Faculty member. One original is to be sent to the Affiliate for their files and one original is to be for the Faculty member’s file.

The Director of Medical Credentialing and Quality Assurance will report the Affiliation Agreement to the Carrier for Liability purposes and monitor for renewal dates. If the Agreement is to be renewed, the Faculty member would follow the process above for the renewal.

Click the following link for a printable PDF of the University of Maryland School of Dentistry Educational Affiliation Agreement (PDF)

Community Service Events Procedure

Subject: I. Academic – A. Student Affairs

Effective Date: 9/10/15

Reviewed and/or Revised: 09/15/2016, 05/26/2017, 09/01/2017, 07/25/2018, 08/25/2021

CLINICAL - For clinical community service outreach activities and health fairs that involve screenings, fluoride varnish, etc., a School of Dentistry Dentist Faculty must be overseeing the event. The following is needed 2 weeks prior to the event for Liability Insurance reasons:
1. Student Activities Information and Guidelines form titled 'Information and Guidelines - Professional Liability Insurance Coverage For Student Volunteer Events with Clinical Activity (PDF)' – needs to be completed and sent to the Director of Medical Credentialing and Quality Assurance at least 2 weeks prior to the outreach clinical event for review and to obtain the Associate Dean of Clinical Affairs signature.
2. Dental Screening Consent form – each patient/participant is to complete and sign the form. Original forms are kept on file by the overseeing Dentist Faculty’s Department and copies are sent to the Director of Medical Credentialing and Quality Assurance.
3. Template Sign in Sheet and Consent - The date on the form will need to be changed and reference the name of the outreach event. Each patient/participant must sign in. Original sign in sheets and consents are kept on file by the overseeing Dentist Faculty’s Department and copies are sent to the Director of Medical Credentialing and Quality Assurance.
EDUCATIONAL - For educational community service, virtual programs, or outreach activities that do not involve screenings, fluoride varnish, etc. a UMSOD Dentist Faculty or Faculty do not need to be overseeing the event. The following is needed 2 weeks prior to the event
1. Complete the following Educational Form titled 'Student Education Activities Form: NON CLINICAL/EDUCATIONAL ONLY (PDF)'. The sponsoring UMSOD Faculty provider and the Faculty provider’s Chairman both sign the form.
2. Submit the signed form to Elyse Markwitz, Director of Medical Credentialing and Quality Assurance at emarkwitz@umaryland.edu.
A list of the names of the students’ needs to be submitted to the Director of Medical Credentialing and Quality Assurance 2 weeks prior to the event stating what the students will be doing at the event.
Faculty is to notify students if they will NOT be assisting at the event and doing other volunteer tasks (such as: setting up, etc.)

NOTE: For a MOU with the KIPP School to deliver an oral health program that includes screening and education for the students, teachers and staff at the KIPP School would have a dental screening for themselves. (As employees, they would not be included in our MOU.) They would screen them using the same procedures for clinical activities that is used for health fairs, which is: sending in a form describing the event, get signed consent forms, and filling out a form listing participants.

Extramural Programs for Operative Dentistry for Students

Subject: I. Academic A. - Student Affairs

Effective Date: July 1, 2017

Reviewed and/or Revised: 09/01/2017

Extramural Programs - Credit in Restorative Dentistry as part of REST 548A Operative Dentistry: (updated 4/2017)

D4 students are assigned in blocks to participate off-site of the School of Dentistry in extramural programs and externships. Extramural programs are differentiated from externships in that there is faculty supervision at Extramural programs (Perryville, Access Carroll and Frederick). For D4 students there is no credit for procedures accomplished in the externships. For those extramural block assignments assigned by the school of dentistry, e.g., Perryville, Access Carroll, and Frederick (other Access programs are in the process of being established), full credit of Operative Procedures accomplished at these sites will be included in the calculation of student clinical grades. To receive credit at Extramural Sites the student is responsible for following the protocols to keep a daily patient diary for single tooth direct restoration procedures (excluding sealants) and complete the forms with supervising faculty signatures for each day of treatment. Each student must complete the forms to include the summary sheet and the student will sign the summary sheet. The student also must attached the printout of procedures completed at the extramural site. This format for completion of forms in the Addendum on this Clinic Manual. For the Perryville extramural block assignment, the Axium summary for Perryville will be used in the grade calculation following the guidelines established above, but it is planned that the Axium will not be available after June 30, 2017. Starting July 1, 2017, the protocol for completing the paper forms will be enforced. Forms are to be placed under Dr. Strassler’s door, room 5253 before the last Friday in April, 2017.

Mission of Mercy

During the School of Dentistry’s Mission of Mercy participation, students will receive credit for their Mission of Mercy procedures in restorative dentistry following the same format as used for Extramural Assignments. The diary form for recording treatment must be used and submitted within 30 days after the Mission of Mercy following the protocols for faculty signature and summary for each day of treatment. The student signature is also required.

All forms are to be placed under Dr. Strassler’s door, room 5253 or Dr. Strassler’s designee.

D3 students can participate in the extramural sites and receive operative credit towards their REST 548A Operative Dentistry (fourth year) grade. Clinical Operative treatment at Extramural sites will not count towards the clinic grade for REST 538A Operative Dentistry but will be included for the dental student in the calculation of the D4 grade for REST 548A Operative as described above. The student must submit the forms that are described above. Forms are to be placed under Dr. Strassler’s door, room 5253 within 30 days after completion of the offsite treatment.

Click the following link for a printable PDF of Class of 2018 Diary of Treatment Provided & Summary for off-site Extramural Block Assignment Form (PDF).

International Travel Requirements/Information

To: School of Dentistry Faculty, Staff and Students
From: Dean Reynolds
Re: IMPORTANT INFORMATION REGARDING INTERNATIONAL TRAVEL (PDF) (Letter from the Dean)
Date: February 15, 2017

Subject: I. Academic – A. Student Affairs

Effective Date: July 1, 2016

Reviewed and/or Revised: 09/01/2017

Welcome to the University of Maryland, Baltimore Global Assistance Program.

Rest assured that whenever you travel internationally or live abroad, the University of Maryland, Baltimore (UMB) has a 24/7 resource on call, online, and even on the ground to help with any medical, security, and logistical questions, concerns, and situations that may arise. If you need a medical referral, lose your medication, want to seek pre-travel advice, or experience a medical or security crisis, UMB has a fully integrated program in place so you receive the care and expertise that you need — whenever and wherever you need it.

UMB has partnered with International SOS, the leading medical assistance, international health care, and security services company. Travel security services are provided by a joint venture of International SOS and Control Risks, the world's leading security risk management firm.

Take advantage of this powerful resource by calling an International SOS Assistance Center, which has physicians, multilingual coordinators, operations managers, logistics support personnel, and medical and security professionals on hand to speak with you.

Also, prepare yourself before traveling by browsing through our various medical and security online tools and signing up for our alerts.

The link is: http://www.internationalsos.com/Members_Home/login/clientaccess.cfm?custno=11BCAS519702

Emergency Contacts:

Contacting International SOS Assistance Centers

Contact an International SOS Assistance Center at any time if you have any questions about the program, International SOS benefits, or the services available to you.

Although members can contact any International SOS Assistance Center at any time, we recommend that you contact the closest lead Assistance Center in case you need emergency medical information once you are stabilized. As a general guideline, we recommend:

If calling from:	Call Assistance Center in:	At this number:
U.S. or Canada	Philadelphia, PA	1-800-523-6586 Call collect: 1-215-942-8226
Mexico or South and Central America	Philadelphia, PA	Call collect: 00-1-215-942-8226
Europe, CIS, Africa or the Middle East	London	Call collect: 44-208-762-8008
Asia, Australia or the Pacific Rim	Singapore	Call collect: 65-6338-7800

*Be sure to know the country's outbound international dialing code before traveling to that country.

International SOS complete Office, Assistance Center and Clinic listing.

FAQs

What is the role of International SOS?

International SOS provides University of Maryland, Baltimore business travelers and expatriates with quality health care and medical and security assistance services worldwide 24 hours a day.

How can International SOS help?

International SOS provides you and your family with assurance that you will be assisted during emergency situations that may arise during travel or international relocation. One phone call connects you to the International SOS network of multilingual specialists for immediate help. International SOS services are designed to help you with medical, personal, travel , security and legal problems when away from home. Call International SOS at any time to speak with a physician or security specialist about simple or critical matters.

How does it work?

Carry the International SOS membership card with you at all times. It includes the telephone numbers of the three major worldwide International SOS Assistance Centers. In the event of an emergency, call one of the emergency phone numbers listed on the card. If you do not have a card, you can print one now.

What do I need to do to use the program?

In order to utilize any of the medical or travel services listed under Membership Benefits, contact any Assistance Center from anywhere in the world by calling directly, calling collect or calling the toll-free number.

To ensure a prompt response when calling, you should be prepared to provide the following:

Your name, location, age, gender and nationality
Your International SOS membership number: 11BCAS519702 (use this code to access the University of Maryland, Baltimore International SOS web site when using the web site)
The telephone number from which you are calling (in case you are disconnected)
Your relationship to the University of Maryland, Baltimore employee (if the person calling is not the employee)
Name, location and telephone number of the hospital, clinic or treating doctor (when applicable)

What if I have pre-trip questions about my travel destination?

In addition to calling the Assistance Center for any pre-trip questions you may have, you can access our Country Guides by selecting a country from the dropdown menu on the left navigation pane. These comprehensive guides provide both medical, security and general travel advice, such as information on the standard of health care, how to pay for medical care, the availability of medications, safety of the blood supply, embassy/visa information, dialing code information, cultural etiquette and financial and voltage/plug information.

Do I need to activate my membership?

No, your membership is already active. Simply carry the card in your wallet at all times while traveling. Whenever you need service, contact one of the emergency phone numbers listed on the back of the card. You do not need to report specific trip dates to International SOS each time you travel.

Are my spouse and children covered under the International SOS program?

Family members are covered under the International SOS program.

What are Email Alerts?

You have the option to sign up for Medical and/or Security Email Alerts. Medical alerts are issued when there is an unusual health risk that, in the opinion of International SOS medical professionals, may negatively impact travelers or expatriates visiting a specific country or region. Security alerts are issued when the combined team of security professionals from a joint venture of International SOS and Control Risks has identified a security risk in a specific country or region.

What do I do if my card is lost or stolen?

You can print the card now.

What if I need a doctor?

The International SOS Worldwide Assistance Centers are listed on the back of your card. Call the International SOS Assistance Center that is nearest to you for a referral to a doctor who speaks your language.

What if I need a lawyer while overseas?

Call the nearest International SOS Worldwide Assistance Center for legal referrals.

What if I need prescription medication?

We can help if you require a prescription that a local physician cannot obtain, or you need to replace lost, stolen or depleted medication. International SOS will, when permissible by local law, send the medication you need.

What if I am hospitalized?

Call the nearest International SOS Worldwide Assistance Center. International SOS will immediately take steps to evaluate the care you are receiving and determine what actions must be taken to ensure your safe and speedy recovery.

What if local medical facilities are not adequate?

If you are hospitalized in an area where adequate medical facilities are not available, International SOS will obtain approval from University of Maryland, Baltimore’s Health and Medical Services to evacuate you to a medical facility capable of providing the required care. A physician supervises evacuations, and when necessary, a medical specialist or nurse will accompany you during the evacuation. An air ambulance will be used when required.

What happens when I am released from the hospital and still need help?

When your condition is stabilized and International SOS has determined that it is medically advisable to bring you home or to a facility near your permanent residence, International SOS will again obtain approval from University of Maryland, Baltimore and arrange the repatriation under medical supervision.

Will International SOS pay my medical bills?

After approval from University of Maryland, Baltimore, International SOS will guarantee and pay all costs associated with your medical care. International SOS will also medically monitor and evaluate your condition and ongoing medical expenses during your hospitalization.

What should I do if I am concerned about my security or in the event of a security emergency?

What is security evacuation assistance and coordination?

We will assist you in the event of threatening situations such as civil and political unrest, insurrections, revolution and similar situations by providing information, guidance and resources in the event personal safety and security can no longer be assured.

How do I access up-to-the-minute information about security alerts, warnings and the latest situations?

You can visit Travel Security Online.

In the event of death...

International SOS will render all assistance possible to obtain clearances and arrange transportation for the return of mortal remains.

Membership Benefits

Medical Services

Emergency evacuation
Medically-supervised repatriation
Companion ticket
Additional travel and accommodation arrangements after medical evacuation
Repatriation of mortal remains
Return home of minor children
Medical monitoring
Inpatient admission and identification of receiving physician
Emergency and routine medical advice
Pre-trip information on travel health issues
Medical and dental referrals
Outpatient referrals
Outpatient case management
Claims assistance
Outpatient medical expense guarantee and payment
Inpatient medical expense guarantee, cost review and payment
Dispatch of medication and medical supplies

Security Services

The joint venture of International SOS and Control Risks provides you access to the following services:

Urgent and non-urgent travel security assistance and advice by telephone
Daily online and email updates on the latest travel security developments
Special Advisory emails with advice in response to significant travel security incidents
Security and travel information on 220 countries and more than 330 cities
Access to security evacuation
Coordination of post-evacuation debriefs and counselling

Travel Services

Legal referrals
Emergency message transmission
Translations and interpreters
Lost document advice
Ground transportation and accommodations for accompanying family members
Emergency personal cash advances

International SOS Clinics

Access to International SOS clinics

International SOS: Worldwide reach Human Touch

How to use UMB’s global medical and security assistance program.

Who is International SOS?

International SOS is the world’s leading medical and security services company

A Global Infrastructure You Can Depend On

27 Assistance Centers Worldwide

CONVENIENCE: Local medical and security expertise provided globally in any language, anytime 24/7/365.

79,000+ accredited providers

DELIVERY: A vast network of accredited healthcare, aviation and security providers ensuring you receive high standards of care in the air and on the ground.

5,200+ medical professionals

EXPERTISE: Immediate access to professionals with extensive experience in all areas of medicine, coupled with a thorough knowledge of the local environment and healthcare system

45+ clinics worldwide

QUALITY: Our set of global protocols and procedures ensures that we adhere to international standards of medicine—even in developing countries (subject to local clinic terms and conditions

Stay healthy, safe and secure

Medical Question or Concern
Medical Emergency
Safety Concern
Security Emergency
Travel Assistance

When you need help, International SOS is there for you.

International SOS provides

Reassurance

One call will immediately start resolution to your situation – whether an emergency or routine advice.

Quality Medical Care

Confidential medical advice from experienced, internationally-trained doctors.
Providers are credentialed by our medical staff to ensure quality treatment.

Peace of Mind

An experienced, culturally knowledgeable partner who operates in nearly 90 countries and locations is there to help you.

Convenient Access

24/7 coverage, 365 days per year offering expert advice in more than 90 languages and dialects.
Comprehensive, up-to-date members only website to keep you informed.

How to reach International SOS

KEEP this card safe and with you at all times.

INFORM friends and family you are an International SOS member. They are welcome to call International SOS for information if they have concerns while you are away.

DOWNLOAD our free app on your smartphone from http://app.internationalsos.com for one-click routine or emergency assistance worldwide – it’s an essential tool for any traveler on the move.

LOGIN to www.internationalsos.com with your membership number to obtain country specific information and to help familiarize yourself with the full benefits of your membership.

CALL us 24/7/365 at +1.215.942.8478 with any health, travel security or personal safety concerns, for routine advice or emergency assistance.

International SOS Assistance App

Call us anytime, anywhere at any of our assistance centers around the world using the Assistance App

In time of need, you can quick dial for immediate help from an International SOS assistance center, whether it’s for an emergency or just advice.
Gives you peace of mind and the ongoing confidence to travel or live anywhere in the world knowing this safety net is always available 24/7/365 simply by pressing a button.
Easy access to timely medical and security alerts for your location, so you are kept aware of changing situations and can quickly adjust plans as needed.
Supplements your International SOS membership card, ensuring you always have your membership card.

Prepare yourself before traveling

Before you leave, prepare yourself:

Access accurate, real-time information on www.internationalsos.com. View country guides, online medical and security reports, and sign up for health and safety e-mail alerts.
Call an assistance center for pre-travel information (i.e. vaccination, required medication and travel security concerns).
Download the Assistance App.

Remember: An ounce of prevention is worth a pound of cure.

Helping you in an emergency

If the “unthinkable” happens, call us to:

Arrange transportation
Monitor your condition and advise
Evacuate you to a center of excellence if local facilities are inadequate or to a safe meeting point when necessary
Contact your family
Coordinate repatriation of mortal remains

UMB’s International SOS Access Page

UMBs International SOS Access Page

International Insurance

All UMB faculty, staff and students are automatically covered by the ACE Travel Assistance Program/International SOS while on UMB sponsored travel

Visit the UMB SOS web portal BEFORE you travel to register and establish a password.
- http://www.internationalsos.com/Members_Home/login/clientaccess.cfm?custno=11BCAS519702
- Membership number: 11BCAS519702
Carry SOS card at all times
Retain U.S. health insurance plan as first insurer; ACE/SOS is secondary.
Domestic insurance (including student insurance through UMB) may or may not cover a specific circumstance; contact your insurance company directly to verify coverage for international use.
Carefully read the SOS Membership Guide before traveling
Note the information that will be required in case of a medical situation.
Program the SOS service emergency number into your cell phone in the host country or call collect outside of the U.S.

SOS Emergency Phone from abroad 001-215-354-5000.

PUT THIS IN YOUR PHONE AND WALLET

Thank You

Bonnie Bissonette

Director

Student Center for Global Education

University of Maryland

SMC Campus Center

621 W. Lombard Street, Suite 306

Baltimore, MD 21201

410.706.6331

bbissonette@umaryland.edu

Memorandum of Understanding (MOU)

Subject: I. Academic – A. Student Affairs

Department: Clinical Affairs

Reviewed and/or Revised: 09/01/2017

Policy and/or Procedure:

The MOU Template is to be used for all MOUs. Allow 2-3 months when processing new and/or renewed MOU Agreements. The 2-3 months’ time frame allows appropriate time for review and to make changes if necessary before the Agreements can be signed and/or approved.

A MOU Agreement needs to be reviewed by the originating Faculty member. The MOU Agreement is sent electronically in a Word Document to the Director of Medical Credentialing and Quality Assurance to be reviewed. If appropriate, the Director of Medical Credentialing and Quality Assurance will send the Agreement to UMB Legal for review.

After the Director of Medical Credentialing and Quality Assurance has reviewed the Agreement, the MOU Agreement is sent back to the Faculty member with any edits or comments if applicable. The Faculty provider will have 3 originals made of the Agreement and signs the Agreement as originator. The Faculty provider will send the 3 originals to the Affiliate to obtain the signature and/or approval of the Affiliate.

If the Affiliate wants any changes made, they need to send them to the Faculty member who will send them to the Director of Medical Credentialing and Quality Assurance to determine if the changes can be made. If no changes to be made, the Affiliate would return the 3 signed originals to the Faculty member who will forward them to the Director of Medical Credentialing and Quality Assurance for review and obtain the Assistant Dean of Clinical Affairs’ signature/approval.

The Director of Medical Credentialing and Quality Assurance will report the MOU Agreement to the Carrier for Liability purposes and monitor for renewal dates.

If the MOU is for an event or recurring events a list of the names of the students need to be submitted to the Director of Medical Credentialing and Quality Assurance to the Assistant Dean of Clinical Affairs 2 weeks prior to the event stating what the students will be doing at the event. Faculty is to notify students if they will NOT be assisting at the event and doing other volunteer tasks (such as: setting up, etc.)

If the Agreement is to be renewed, the Faculty member would follow the process above for the renewal.

Click the following link for a printable PDF of the University of Maryland, Baltimore The Baltimore College of Dental Surgery Memorandum of Understanding for Student Experiential Training (PDF)

Non-UMSOD Student and/or International Scholars Shadowing Resident in Post Grad And PreDoc Clinics

Subject: I. Academic – A. Student Affairs

Department: Clinical Affairs

Origination Date: July 2016

Reviewed and/or Revised: 09/01/2017, 09/30/18

NON-UMSOD Students and/or International Scholars who are shadowing Faculty, Residents and/or Students on the Clinic Floor in the Post Grad Programs or Predoc Program can chairside assist in providing patient care if they have taken and have the following on file with UMSOD:

CPR
Bloodborne Pathogens (BBP/OSHA - via Blackboard Clinic Essentials)
Start of Day Video & Assessment for STUDENTS & RESIDENTS (SODA/S - Via Blackboard Clinic Essentials)
HIPAA (via Blackboard)

If they are here to ONLY observe and have no patient contact, they need to have the following on file with UMSOD:

HIPAA (via Blackboard)

Note: In addition, they need to fill out and complete the Student Volunteers form and Confidentiality Agreement and send to the Director of Medical Credentialing and Quality Assurance prior to being in the clinics.

NOTE: The following appropriate forms need to be completed and signed by the appropriate persons before visiting in the clinic and submitted to Director of Medical Credentialing and Quality Assurance prior to the visit.

Observation Form for Visitors
Confidentiality Agreement
Visiting Scientist Agreement/Intellectual Property Agreement
Visitor/Volunteer Agreement PDF (School retains original. Volunteer retains a copy.)

Office of Admissions Process:

The application process and requirements can be found on website https://www.dental.umaryland.edu/ce under Advanced Programs for Internationally-Trained Dentists. Listed below are the requirements.

Admission Process

After applicants have submitted all required documentation, the applications will be reviewed by the admissions committee. As required, a personal or phone interview may be scheduled with the applicant. Admission criteria to the Advanced Specialty Programs include, but are not limited to: academic achievements, demonstrated interest in that specialty, TOEFL scores and performance at previously attended academic programs, clinical experience and letters of recommendation. Listed in the Application requirements below are some of the requirements. Each Program lists its requirements on the website.

Application Requirements

Completed application form
Application fee
Curriculum Vitae
Personal statement / letter of intent
ECE course-by-course evaluation
Notarized copy of dental school diploma/degree and original transcripts
Three Letters of recommendation
TOEFL score reports

English Language Test Requirements:

TOEFL (minimum 80 internet based test, 550 paper based)*
IELTS (minimum 7.0 total bandwidth score) please attach results*

*Scores from these exams must be no more than two years old at the time of submission of the J-1 request.

Observation Form for Visitors

The University of Maryland School of Dentistry must abide by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This act sets standards for national electronic health data systems, simplifies submission of electronic insurance claims. In addition, it contains comprehensive regulations safeguarding the privacy of patients.

Before you will be allowed to observe the treatment of patients in the Dental School, you will need to sign a Confidentiality Agreement. By signing this agreement, you agree to abide by the privacy regulations of HIPAA. Briefly, you cannot disclose any of the following patient information:

Name	Account number
Address	Certificate/license number
Birth date or age	Vehicle ID and serial numbers
Telephone & FAX number	Device ID and serial numbers
Email address	Web addresses
Social Security number	Internet Protocol address numbers
Medical record number	Biometric IDs
Health plan beneficiary number	Capture full-face photographs of patients

Examples of violations

Telling a friend that someone is a patient at the Dental School.
Talking about the patient in an identifiable manner in the hallway or elevator.
Disclosing that someone is a patient in a situation that is not related to the patient’s treatment (i.e., telling others about famous people you saw treated at the Dental School).

There are stiff fines for the violation of these regulations,

$50,000 fine + one year in prison for improper disclosure of health information.

$100,000 fine + five years in prison for obtaining health information under false pretenses.

$250,000 fine + ten years in prison for using health information for personal gain.

Additional Forms

Foreign National Visiting Scientist Questionnaire

Student Acting as Patients Policy and Procedure

Subject: I. Academic – A. Student Affairs

Department: Clinical Affairs

Reviewed and/or Revised: 09/01/2017, 05/01/2017

Policy Statement

To ensure student safety and inform prospective students of participation expectations.

Procedure

Each Student must be screened and have a chart made except as noted below.

Faculty specifies parameters for partner/classmate exercise.

Student to follow Faculty instructions.

Note: State and Federal Laws specifically prohibit Radiography as being a part of the classroom activity or clinical demonstration. (See COMAR 26.12.01.01 page 41 Section F.3 – “General Requirements” subheading: (a) “Administrative Controls”:

Note: As part of the education process, students in all of the School’s clinical programs are required to provide treatment for patients and practice techniques with student-partners. Students are required to serve as patients for their classmates in performing such diagnostic and reversible procedures as local anesthesia administration, sealant placement, and oral prophylaxis. The Dental School has the responsibility of ensuring timely and safe treatment of all patients during these processes. Individuals have the option of electing not to service as patients during such clinical exercises. These instances will be managed on a case-by-case basis by the faculty.

Note: The Dental School recognizes that health issues that are not disabilities may arise during the course of a student’s enrollment. These situations may require the student to be absent from the academic program for a period of time, or may limit the student’s participation in certain educational experiences. In certain instances, modification of a student’s educational program may be necessary. Possible modifications may include short term leaves of absence or customization of the student’s schedule of course work. The impact of these adjustments may be a delay in the student’s progress toward graduation. While reasonable efforts will be made to support the student, an extension o f the educational program may be necessary.

Student Externship Agreements Learning Experiences

Subject: I. Academic – A. Student Affairs

Effective Date: September 16, 2015

Reviewed and/or Revised: 10/6/2016, 09/01/2017

Definitions: The Fourth Year Service Learning Externship is a three week clinical rotation that provides students with the opportunity to experience dental practice in a setting outside of the dental school

Policy and/or Procedure:

Student Externship Agreements Learning Experiences

Student Externship is a three week clinical rotation that provides students with the opportunity to experience dental practice in a setting outside of the dental school. This applies to all fourth year dental students.

The student should consult with Dr. Scott Swank, Externship Program Coordinator, to determine whether the Dental School has a current Affiliation Agreement with the proposed site. Affiliation Agreements are required in order for the Dental School’s liability insurance carrier to cover the student’s activities at the site.
If there is no current Affiliation Agreement with the site:
1. The student may request that an institutional Affiliation Agreement be established. This request must be submitted in writing to Dr. Scott Swank, Externship Program Coordinator. Institutional Affiliation Agreements may take up to two-to-three months to complete.
2. If an institutional Affiliation Agreement cannot be established then it will be the student’s responsibility to obtain their own liability insurance.
The extramural site documents requiring signature by the Dental School will be signed by Dr. Manski and Dr. DePaola, Assistant Dean of Clinical Affairs.

Student Judicial Policy

Subject: I. Academic – A. Student Affairs

Effective Date: July 2016

Reviewed and/or Revised: 09/01/2017

The Student Judicial Policy applies to students in the Dental School DDS program, Bachelor of Dental Hygiene program, and students in Advanced Dental Education certificate programs: Advanced Education in General Dentistry (AEGD), Endodontics, Orthodontics, Pediatric Dentistry, Periodontics, and Prosthodontics. Students are obliged to carry out his or her designated responsibilities within the rules and governance structure adopted and agreed to by the community as a whole. Accordingly, student actions and behavior in the clinic are subject to review as described in the Student Judicial Policy.

This academic community has interrelated responsibilities of producing and disseminating new scientific knowledge, teaching, caring for patients, and educating individuals to carry on these same functions. In carrying out these responsibilities, the academic community needs rules to guide the maintenance of high standards.

Student Responsibility Statement

Subject: I. Academic - A. Student Affairs

Department: Clinical Affairs

Reviewed and/or Revised: 09/01/2017

Click the following link to access a printable PDF of the UMSOD Student Responsibility Statement (PDF).

UMSOD Student Responsibility Statement (Updated 10/09/20)

OVERALL GUIDELINES

The primary goal of all UMSOD clinics is to ensure that patient-centered care is the priority.
- Patients should expect to be treated with high ethical standards, and students should exhibit qualities such as honesty, compassion, kindness, courtesy, integrity, fairness, and charity.
- Students must always strive to do what is right and in the best interests of the patient.
Students must provide patient-centered treatment at ALL times.
- Students will provide timely and high-quality dental treatment to ALL assigned patients.
  - This includes dental care provided to same-day “emergency” patients.
- Students must attend ALL block assignments, clinical rotations, and assigned externships.
- Students must arrive on time to their designated clinic sessions or block assignments and must be dismissed by faculty before leaving.
- If students are not treating patients for a session, they must be reachable via cell phone or email and be able to return to the clinic floor ASAP.
  - The PCC for each GP will maintain a current list of phone number/emails.
- Students MUST ask faculty to intervene if they are unable to complete a treatment in a reasonable amount of time.

GENERAL RULES

Clinic Policies and Procedures
- Students must follow all UMSOD policies and procedures contained in the clinic manual.
- All dental treatment must be performed in designated clinical spaces under the direct supervision of a licensed faculty member.
- No patient dental care may be performed in Dental laboratory and/or Simulation spaces.
- Patients/visitors may not enter non-clinical spaces unless they are approved by Clinical Affairs.
Health Insurance Portability and Accountability Act (HIPAA)
- Students must understand and follow all rules related to HIPAA.
- Students must remember that all patient information is the explicit property of the patient and the SOD.
- Patient images may NOT be published on social media.
- All mobile devices must be registered with the UMSOD Office of Information Technology
- All laptops and mobile devices must be encrypted and password-protected
- All patient images must be uploaded into the patient management system.
- No patient information is publicly accessible.
- Any HIPAA infraction is considered very serious and may result in a loss of clinical privileges.

CPR status
- Students must maintain a current CPR status (required recertification every 2 years) in order toworkinclinic.
  - Note: this CPR certification will be maintained on file with the UMSOD Director of Credentialing and Quality Assurance.
Swipe cards

Students CANNOT use faculty swipe cards, and faculty should NOT give their swipe cards to students to be used.
- This is considered fraud and is a legal matter of “impersonation.”

Clinic missteps
Chart documentation
- ALL clinical documentation must be maintained in the patient’s Electronic Health Record (EHR), which includes:
  - All treatment notes,
  - Any relevant patient conversations/comments related to treatment, including, but not limited to:
    - Restoration shade approvals,
    - Verbal consents,
    - Specific questions.
  - The patient’s medical history/medications must be updated and approved at each visit (including BP).
Adverse incidents
- Students must immediately report any adverse incidents to the covering faculty.
- Students must complete all documentation and report any adverse incidence to the Emergency Response Team, which includes:
  - Incident Report Form,
  - A relevant note in the patient’s EHR
Infection Control
- Students must wear appropriate Personal Protective Equipment (PPE) that is compliant with Occupational Safety and Health Administration (OSHA), Centers for Disease Control and Prevention (CDC), and UMSOD Policies and Procedures:
  - Appropriate school-issued scrubs and closed-toed footwear,
  - Disposable blue jacket/coat,
  - Eye protection with side shields,
  - Properly fitting gloves
  - A mask that covers the nose.
- Scrubs approved by the UMSOD must be worn for all clinical, preclinical and lecture activity.
  - The proper color for each class should be worn.
- In addition, all hair should be properly contained (hair should be pulled back and off the face), and men should be neatly groomed.
- Students must properly disinfect the patient’s chair and all necessary equipment and apply all required barriers prior to seating the patient.
  - Students must properly remove all barriers and then properly disinfect the patient’s chair and all equipment after dismissing the patient.
- Disposable blue gowns/coats
  - UMSOD provided disposable blue gowns/coats must be worn during all patient contact/treatment.
  - Gowns must be worn ONLY in the clinical areas!
  - Gowns must NOT be worn in restrooms, in eating areas, or outside of clinic.
  - Gowns must be disposed of in the white cloth bins.
    - DO NOT place them in the trash OR in the red biohazard waste bags.
- Biohazard waste (RED bags)
  - Biohazard bags must be used for disposal of single-use items having come into contact with a patient.
    - Ex: GLOVES, gauze, cotton rolls, suction tips
  - Note: anesthetic carpules and syringe needles, scalpels, scalpel blades and other recognizable sharps should be placed in the RED SHARPS container.

BEFORE SEATING THE PATIENT

Students must ensure that their patient has been “checked in” at the front desk.
Patients are responsible for paying any past-due balance prior to being seated.
- If an outstanding balance cannot be paid, the patient should be escorted to the business manager to make financial arrangements.
If there is a problem with payment and/or collection of an outstanding balance, students must discuss this with their GP director/assistant director before providing any additional treatment, unless the treatment is of an emergency/urgent nature.
Ideally, all financial transactions will have been satisfied by the front desk staff prior to the patient being seated for treatment, however, it is ultimately the student’s responsibility to verify that the patient’s account balance is current.

GETTING A “START”

Students must review the chief complaint, current radiographs, medical history, and take a current BP before requesting a “start” from faculty.
- Once the “start” has been granted, the student may begin clinical examination and/or treatment of the patient.
All dental treatment planned for the day must be reviewed and approved by the covering faculty before treatment is started.

PATIENT CONSENT AND COMMUNICATION

Students must obtain all appropriate patient AND faculty consents before rendering treatment.
Students should constantly be working to improve their patient communication skills, including:
- Active listening skills,
- Explaining procedures appropriately to ensure that patient comprehension,
- Giving patients the opportunity to ask questions.

BEFORE DISMISSING THE PATIENT

Students must ensure that all treatment is entered/swiped in Axium and approved/completed by faculty prior to the patient being dismissed.
Students must walk their patient to the front desk to check out.

I have reviewed and understand the above clinic Student Responsibility Statement and agree to accept the above referenced responsibilities while working under the supervision of faculty in clinic.

Print name: _____________________________________________ GP: ______________

Student signature: ________________________________________ Date: ____________

Student Visitors in UMSOD Clinics

Subject: I. Academic – A. Student Affairs

Department: Clinical Affairs - Clinics

Origination Date: 01/01/16

Effective Date: 01/01/16

Reviewed and/or Revised: 09/01/2017, 11/16/2020, 10/04/2021

Policy and/or Procedure:

The following is needed for the visitors to be in the clinic and needs to be submitted to Director of Medical Credentialing and Quality Assurance prior to the visit:

The Visitor/Volunteer Agreement Form PDF (completed and signed by the visitors)
The Confidentiality Agreement Form
If they are going to be outside the splash zone (outside of the cubicles), then no CPR is needed.
If they are going to be within the splash zone (inside the cubicles), a copy of their current signed CPR copy (front and back).
Clinic Essentials training and assessments in Blackboard are required upon arrival at UMSOD. The visitor’s information needs to be added to the UMB Community Directory by the appropriate Department Administrative person, so the visitor has access to Blackboard to review the Clinic Essentials requirements and take and pass the associated assessments in the VISITORS & OBSERVERS FOLDER.
Proof of COVID-19 vaccination needs to be submitted with the attached signed Visitor forms.
For those within the splash zone: An OSHA Respiratory Questionnaire needs to be completed and signed and sent to the Director of Medical Credentialing and Quality Assurance. The person completes the OSHA Questionnaire form [regarding page 1 respirator section, please check off both a and b (half face)], sign and date page 3, print and email as a PDF file to: emarkwitz@umaryland.edu. Once the form has received medical clearance, the person is scheduled for a mask fit test.
For those outside of the splash zone: A KN95 mask and face shield needs to be worn by the visitor while in clinical areas.
A KN95 face mask needs to be worn at all times while in the UMSOD building.
Social distancing guidelines are to be performed.

Observation Form for Visitors

Name	Account number
Address	Certificate/license number
Birth date or age	Vehicle ID and serial numbers
Telephone & FAX number	Device ID and serial numbers
Email address	Web addresses
Social Security number	Internet Protocol address numbers
Medical record number	Biometric IDs
Health plan beneficiary number	Capture full-face photographs of patients

Examples of violations

Telling a friend that someone is a patient at the Dental School.
Talking about the patient in an identifiable manner in the hallway or elevator.
Disclosing that someone is a patient in a situation that is not related to the patient’s treatment (i.e., telling others about famous people you saw treated at the Dental School).

There are stiff fines for the violation of these regulations,

$50,000 fine + one year in prison for improper disclosure of health information.

$100,000 fine + five years in prison for obtaining health information under false pretenses.

$250,000 fine + ten years in prison for using health information for personal gain.

A. Student Affairs

1. Additional Externships Beyond the Fourth Year Service Learning Experiences Policy

Affiliation Agreement Policy

Community Service Events Procedure

Extramural Programs for Operative Dentistry for Students

International Travel Requirements/Information

Memorandum of Understanding (MOU)

Non-UMSOD Student and/or International Scholars Shadowing Resident in Post Grad And PreDoc Clinics

Student Acting as Patients Policy and Procedure

Student Externship Agreements Learning Experiences

Student Judicial Policy

Student Responsibility Statement

Student Visitors in UMSOD Clinics

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