Patient Rights & Responsibilities

As a patient at GSDM, you have the right to:

Care and Treatment: 

  • Prompt, life-saving treatment in the event of a dental emergency, without discrimination or delay because of your economic status or how you will pay.
  • Refuse to serve as a research subject.
  • Refuse any care or examination when the primary purpose is educational or informational rather than therapeutic.
  • If you are refused treatment for economic status or lack of a source of payment, assistance in transferring your care to a facility that agrees to treat you.
  • Refuse to be examined, observed, or treated by students or any other staff member.
  • Except in an emergency, choose an available facility and physician, and the type of health service for your care, provided the facility, physician, or health service is able to accommodate you.

Communication: 

  • Obtain a copy of GSDM’s rules and regulations relating to patient conduct.
  • Obtain the name and specialty of those providing care to you upon request.
  • Obtain information about the relationship of GSDM and your treating providers with any other healthcare facility or educational institution, as it relates to your care, upon request.
  • Receive information necessary to make an informed decision about the recommended procedure/treatment (including benefits, risks, and available alternatives), to the extent provided by law.
  • Have reasonable requests responded to promptly and adequately within GSDM’s capacity.

    Privacy and Confidentiality:

    • Privacy during treatment and rendering of care.
    • Confidentiality of your records and communications to the extent provided by law.

      Medical Records and Financial Information:

      • Inspect and get a copy of your medical records, upon request.
      • Receive an itemized bill (regardless of the sources of payment) upon request and have a copy sent to the provider responsible for your care at GSDM.
      • Obtain information regarding any financial assistance or free health care, if any, upon request.

        As a patient at GSDM, I have the following responsibilities:

        1. Teaching Institution.  I am responsible for understanding that GSDM is a teaching institution. My provider will be a student practicing dental medicine under the supervision of a licensed faculty dentist. I understand that I may not be accepted as a patient if my dental needs are not appropriate for GSDM’s educational mission.
        2. Accurate Information. I am responsible for providing accurate and complete information regarding my medical and dental history. I am also responsible for providing accurate information regarding my dental insurance.  In addition, I am responsible for notifying GSDM of any changes during the course of my treatment to my insurance and my medical history.
        3. Keeping Appointments. I am responsible for arriving promptly for my scheduled appointments, and for and remaining for the entire duration of the appointment. I am responsible for telephoning at least 48 hours in advance if I cannot keep a scheduled appointment.
        4. My Responsibility for my Dental Health. I am responsible for my dental health and for making decisions about my treatment. I am responsible for following the treatment plan that I agreed to with my provider to maintain continued care and being compliant to the instructions I am given. I am responsible for any follow-up communication and scheduling for my continued treatment.
        5. Conduct. I am responsible for behaving respectfully and with courtesy toward other patients and toward all students, faculty, and staff of GSDM. My behavior will not be disruptive or threatening. I will respect the physical property of GSDM. Your care may be discontinued if you display or use inappropriate behavior or language.
        6. Prohibited Behaviors.  I will not smoke or use alcohol or drugs in and around the GSDM facility. I will not bring weapons into any GSDM facility.
        7. Financial Responsibility. I understand I need to pay for my dental services, and I must state my agreement with the fees prior to signing my treatment plan. When I have signed my treatment plan, I acknowledged that changes may become necessary during the course of treatment and, if that is the case, my provider will explain these changes to me including any change in cost. I am responsible for payment at the time of treatment. If I have dental insurance that GSDM are in contract with, GSDM will bill my insurance company, and I will pay all applicable co-payments, co-insurances, at the time of service.  I will also be responsible for any fees that my insurance company doesn’t pay. GSDM is not responsible for monitoring my insurance coverage.  If I do not have dental insurance, or if my insurance does not cover the services listed in my treatment plan, I will pay in full for services at the time of treatment. I acknowledge that the Fee Estimate is an estimate only, and my final fees for this treatment may be different. Any changes in my treatment may change the amount of fees I will owe. The fee estimate is based on the GSDM fee schedule currently in effect. That fee schedule may change annually and that may affect the final amount due for my treatment. If I have questions about the fees during my treatment, I will talk to my provider or a Patient Care Coordinator. If I fail to pay fees as they are due, I understand that GSDM may discharge me as a patient.
        8. Children. I understand I cannot bring any minor children into any patient care/ treatment areas at GSDM when I have an appointment, and I cannot leave minor children unattended in the reception and waiting areas while I am receiving care. (The Pediatric and Orthodontic departments have discretion to make exceptions).
        9. Cell Phones. I am responsible for setting my cell phone and any other personal electronic devices to silent or vibration mode at all times when I am in the patient treatment center. I will exercise common courtesy while using the cell phone in patient waiting areas. I will not take videos, pictures, or audio recordings anywhere in the school or Patient Treatment Center.

          I understand that if I do not fulfill my responsibilities listed above, GSDM may discontinue treatment after providing me notice and the opportunity to obtain the services of another dentist.