Patient Bill of Rights

Each patient is entitled to

Considerate, respectful, and confidential treatment

Continuity and completion of treatment
Access to complete and current information about his/her condition
Advance knowledge of the cost of treatment
Informed consent
Explanation of recommended treatment, alternate treatment, the option to refuse treatment and risk of no treatment
Emergency, incremental, and total patient care
Treatment that meets the standard of care in the profession
Access to a patient advocate

Standards of Care for Dental Hygiene Division:

At least 80% of all patients will receive dental hygiene preventive maintenance at their designated recall interval
100% of all adult patients will be screened for hypertension.
100% of all patients will be screened for head, neck and oral cancer.
100% of all dental hygiene patients will receive oral hygiene instruction.
95% of all patients with treatment needs will be referred to the appropriate individual(s) for treatment, e.g., undergraduate dental student, post-graduate specialty clinic, etc.

Please also review additional standards on the ADHA website

General Policies and Initial Consent

The Dental School treats patents and trains future dental hygienists, dentists and dental specialists. Students provide patent care under faculty supervision. If your dental needs are too complex for students, you may be referred to graduate dental clinics, other treatment facilities including the Dental School’s Faculty Practice office, or private practices.
Emergency dental service is provided for the treatment of dental emergencies only (pain, swelling, acute infection, bleeding, etc.), and is limited to only such care as is necessary to relieve the emergency. Routine treatment cannot be obtained through this service. Patents desiring regular dental care may make an appointment and be subject to the rules and regulations of the clinical teaching program of the Dental School. A treatment plan examination, including dental x-rays and necessary diagnostic aids, will be required at an additional cost.
The Dental School may accept you as a patient for comprehensive care after your diagnostic evaluation and treatment plan are complete.
A small diagnostic fee may be charged for your initial screening and x-rays. This fee is non-refundable. Another small fee may be charged for the formulation of a treatment plan. This may require more than one visit to the Dental School by you so that faculty can evaluate your oral health. The additional treatment plan fee, if charged is also non-refundable.

After initial evaluation, you may need further diagnostic work or preventive and/or emergency procedures before the Dental School can develop a comprehensive treatment plan for you. These preliminary services might include:

Photographs, other x-rays and models of teeth	Restoration of teeth (fillings)
Examination of teeth and other oral soft tissues	Use of local Anesthetic
Cleaning of teeth	Root Canal treatment (endodontic)
Fluoride treatment

Charges for preliminary services are not included within the diagnostic fee. You will be advised of costs of recommended preliminary services:

You may refuse any proposed preliminary service. However, if you do so, you may not be able to receive a comprehensive treatment plan and further care.

Fees for additional services will be explained when the comprehensive treatment plan is presented to you. An estimate of the cost for each service will be given to you before treatment. The estimated cost of a service must be paid at the initiation of that treatment. Actual costs will reflect services provided, and may be higher or lower than the estimates. Any additional payment due from you will be due upon completion of services. Any refunds will be made only by University check which may take 4-6 weeks to process.
The Dental School cannot assure you that one student dentist will complete treatment within one school year. Another student may need to complete your treatment in a subsequent school year.
Your treatment may be discontinued if you do not keep two appointments without notifying the Dental School, you repeatedly cancel appointments, you repeatedly are late for appointments, or you are uncooperative with students or staff.
The Dental School accepts applications from all people, regardless of age, sex, sexual orientation, race creed, color, national origin, or disability.
All Dental School patient records are the property of the Dental School. Upon your written request, the Dental School will release copies of the information in your records. There is a charge for duplication or delivery costs. Since the School is a teaching institution, your written records, photographs, casts and other clinical information may be used for education purposes. Your patient identifying information will be removed before such uses. Your case may be discussed confidentially amongst students, faculty and professional staff.
Infrequent risks and complications are known to occur as a result of dental procedures. The most common risks are biting the tongue or lip following the administration of local anesthetic and soreness around the area treated. Less common complications include infection, swelling and reaction or allergy to anesthesia or dental care products.
By signing below you acknowledge that the nature and purpose of the diagnostic procedures have been explained to you in general terms.
You realize that good results are expected, but that no guarantees, express or implied, are given for treatment results. You acknowledge that alternative procedures, if any, have been explained, along with their advantages, disadvantages and risks, and that you have had the opportunity to ask questions about the treatments listed above. You understand that you have the right to ask questions and be provided answers to questions during the course of treatment.
You are free to withdraw consent to treatment at any time.
By signing below you acknowledge that you have read and understood this document. Your signature constitutes acceptance of the policies discussed above and an initial consent for diagnostic examination (including x-rays) and treatment.
I hereby acknowledge that I received a copy of this institution’s Notice of Privacy Practices.
I will provide an accurate and up to date medical and dental history for myself or person I am legally responsible for (Must be a legal guardian).

Privacy Officer: Kent Buckingham

Director of IT and Facilities Management, HIPAA & IT Security Officer, Dental School Center for Information Technology Services,

University of Maryland,

650 West Baltimore St., Room G424, Baltimore, MD 21201 KBuckingham@umaryland.edu

(410) 706-0343

(410) 706-3389 FAX