Your Rights as a Patient of the School of Dentistry

1. The School of Dentistry is committed to providing you with appropriate dental care and treatment in a considerate, respectful, and confidential manner, that respects you, your family’s values, and your needs, regardless of your race, gender, age, national origin, religion, sexual orientation, or disability.

2. The School of Dentistry strives to provide you with timely dental care within the environment of an academic dental program. As part of the School’s educational process and the level of faculty supervision required in the student clinics, appointments may be lengthier than in a private dental practice, and more visits may be required.

3. The School of Dentistry will provide you with information about the approximate cost of the treatment to be rendered prior to the beginning of treatment. You should understand that the fee for services may change before this treatment is completed.

4. You may receive care from various programs throughout the School’s clinics. You will receive an explanation of the recommended treatment and any alternate treatment, as applicable, as well as the risks and benefits of the treatment (and what may occur if an existing dental condition is not treated).

    I.    You will have the opportunity to be meaningfully involved in the decision-making concerning your treatment at the School of Dentistry, as well as in a discussion of any health-related behaviors and self-management related to that treatment.
    II.    The School of Dentistry will provide you with informed consent after your assessment(s) and before treatment begins, unless the circumstances require that emergency care must be provided or the treatment is being done to develop a treatment plan.
   III.    The School of Dentistry strives to make you comfortable in signing an informed consent. You are an important partner in your dental care, and you should ask questions, as needed, so that you can understand the informed consent and the treatment to be provided.

Please note: The School of Dentistry will communicate with its patients in a culturally appropriate manner, in a language and at a level that the patient understands. The School of Dentistry always wants to include patients in the treatment planning process to the level that is comfortable for them.

5. The School of Dentistry will inform you about the health care team (dental student, dental hygiene student, graduate dentist, and/or faculty member) who will be directly responsible for your care, including the names of the team members, and how you may receive assistance in case of a dental emergency.

6. The School of Dentistry will provide you with information regarding continuation of care after completion of the dental treatment.

7. You may withdraw your consent to treatment, and may discontinue participation in the treatment or activity, at any time.

8. You have a right to receive a copy of information found in your dental records. A Federal privacy law, known as HIPAA, grants patients the following rights: the right to request amendments to patient information in some circumstances; the right to request certain restrictions to the use of patient information; the right to request an alternate means of communication; the right to request an accounting of anyone who has used or accessed patient information for any means other than for treatment, payment, and/or healthcare operations; the right to receive the School’s Privacy Notice; and the right to make a complaint if patients believe their privacy rights have been violated. Please submit Form 09HIP for Adults, or Form 09aHIP for Minors (see submission information on the form).

If at any time you have a concern or complaint about your rights and responsibilities as outlined above, inappropriate behavior you have experienced or witnessed, the dental treatment being provided by the School of Dentistry, or any of the School’s providers, you should contact the Office of Quality Assurance and Accountability, at 502-852-1187 or email dentalqa@louisville.edu.

Patient Concerns Form

The University of Louisville School of Dentistry strives to provide quality work and service in an environment that promotes respect for all.

Patients have the right to express concerns or complaints with the assurance that the submission of a concern will not compromise the quality of care or future access to care.  In order to address any concerns that you may have, please mail us a completed Patient Concerns Form.

Patient Responsibilities

Each patient of the School of Dentistry is expected to:

• Be respectful of others, including the School of Dentistry’s providers, staff, and other patients, families and visitors. The School of Dentistry will not tolerate inappropriate language (including discriminatory or harassing comments), violent, angry or disruptive behavior, or threats of harm, from either patients and their family/visitors, or from its providers and staff. The School of Dentistry reserves the right to terminate its provider-patient relationship with patients who exhibit inappropriate behavior. Patients who feel they have witnessed or experienced inappropriate behavior from providers, staff or others at the School should contact the Office of Quality Assurance and Accountability at 502-852-1187 or email dentalqa@louisville.edu.
• Pay for services at each appointment, comply with an established schedule of payment, and/or provide accurate insurance and billing information.
• Come to all scheduled appointments and arrive on time. Patients who arrive 15 minutes or more after the appointment time may be sent away without treatment.
• Maintain good oral health habits between visits and follow the agreed-upon treatment plan, including follow-up instructions. Patients are responsible for outcomes related to their failure to follow the care instructions and treatment plan.
• Inform the School of Dentistry’s providers or staff if they have any questions or concerns about their care and treatment.
• Have a parent/guardian present for patients under 18 years of age. Children who accompany adult patients will not be allowed to remain in the treatment cubicle during the appointment period.
• Turn off and put away cell phones while in the treatment cubicle.

NO-SHOW POLICY

The School of Dentistry reserves the right to terminate the provider-patient relationship with patients who have:

• 2 no shows, late arrivals, and/or cancellations with less than 24 hr. notice within a 3-month period.
• 3 no shows, late arrivals, and/or cancellations with less than 24 hr. notice within a 1-year period.