If you are already a patient at UB Dental, please call 716-829-2824 to make an appointment. If you must cancel an appointment, please provide 24 hours' notice by calling your dental student or their coordinator.
REV. 1-12-2024; APPR. CC 4-29-2024
You have a responsibility to:
REV. 1-12-2024; APPR. CC 4-29-2024
The dental care you will be receiving is being provided by student dentists. These student dentists are in the process of completing necessary academic as well as clinical requirements to obtain a Doctor of Dental Surgery (DDS) degree. If, for any reason, you have a concern or comment regarding the treatment that is being provided, always consult with your student dentist and supervising instructor first. If satisfaction is not received you have the right to access our Patient Advocate.
The UB School of Dental Medicine’s Patient Advocate can be reached:
Hours are by appointment. You may also contact the New York State Department of Health’s Office of Health Systems Management.
The University at Buffalo School of Dental Medicine (“UBSDM”) offers optional electronic communication for patients. Electronic communications from the UBSDM may include the Patient Portal, email or text messages. Electronic communication can be a useful tool for your dental care, however, it is important that you understand the risks of this form of communication as well as your responsibilities if you decide to participate in this service. By allowing electronic communications with the UBSDM, you are agreeing to comply with and be bound by the following terms of use. Please review the following terms carefully. If you do not agree to these terms, you should not allow electronic communication with the UBSDM.
General Terms
Accuracy and Integrity of Information
Although the UBSDM attempts to ensure the integrity of all electronic communications, it makes no guarantees whatsoever as to the correctness or accuracy of the information contained therein. It is possible that electronic communications could include typographical errors, inaccuracies or other errors. In the event that an inaccuracy arises, please inform the UBSDM so that it can be corrected. Information disseminated via electronic communication may be changed or updated without notice.
Risks and Limitations of Electronic Communication
The UBSDM will use reasonable means to protect the security and confidentiality of information transmitted via electronic communication, however, it is important that you are aware of the inherent risks and limitations of this form of communication. Electronic communications present the risks of breach of privacy or confidentiality, difficulty validating the identity of parties and potential delays in response. Electronic communications may be misdirected, which increases the risk of receipt by unintended or unknown recipients. Back-up copies may be stored on a computer system even after the sender or recipient have deleted copies of electronic communications. Electronic communications may also inadvertently introduce malware into a computer system, which could damage or disrupt the computer, network or security settings. Some forms of electronic communications, such as text messaging, may incur additional fees or charges with your cell phone carrier.
Minor Eligibility
An individual must be age 18 or older to agree to electronic communications with the UBSDM. Parents or legal guardians of minor patients may request to receive electronic communications regarding the minor patient.
Proxy Access to Electronic Communications
UBSDM patients age 18 or older who have medical decision-making capacity may request that electronic communications be provided to another adult individual (“proxy”) by completing the UBSDM Authorized Representative Form and submitting it to the UBSDM.
Legally authorized decision-makers of adult patients who lack medical decision-making capacity may request electronic communications by completing the UBSDM Authorized Representative Form and submitting it to the UBSDM.
The UBSDM reserve the right to revoke proxy access at any time for any reason.
Opting Out
Electronic communications are an optional service the UBSDM provides to patients. You may withdraw your consent to participate in electronic communications at any time. Please contact the UBSDM at 716-262-9750 to opt out of electronic communications.
Governing Law
This Agreement shall be governed by New York law notwithstanding any conflicts of law provisions to the contrary.
Terms for Communications Involving Protected Health Information
Dental/Medical Advice Disclaimer
Never use electronic communications for a medical or dental emergency or urgent health issue. Contact emergency personnel if you need immediate help with a medical emergency. Please review the UBSDM’s Emergency Care webpage for information about seeing care for dental emergencies at the UBSDM.
Privacy of Your Health Care Information
The privacy of patients’ protected health information (“PHI”) is protected by state and federal laws including the Health Insurance Portability and Accountability Act (“HIPAA”). If you have questions or wish to learn more about the privacy and security of your protected health information at UBSDM, view the Notice of Patient Privacy. Please note that an Authorization for Release of Health Information form must be completed if you request that your health information is sent to another individual that is not a licensed healthcare provider directly involved in your care.
Terms for Communications Not Involving Protected Health Information
Copyright
The content, organization, graphics, design, compilation, magnetic translation, digital conversion and other matters related to electronic communications from the UBSDM are protected under applicable copyrights, trademarks and other proprietary (including but not limited to intellectual property) rights. The copying, redistribution, use or publication by you of any such matters or any part of UBSDM electronic communications, except as otherwise permitted by this document, is strictly prohibited. You do not acquire ownership rights to any content, document or other materials viewed or transmitted through the UBSDM’s electronic communications. The electronic transmission of information or materials does not constitute a waiver of any right in such information and materials. Some of the content transmitted via electronic communications is the copyrighted work of third parties.
Limited License; Permitted Uses
You are granted a non-exclusive, non-transferable, revocable license (a) to access and use electronic communication methods offered by the UBSDM strictly in accordance with this Agreement; (b) to participate in electronic communication methods offered by the UBSDM solely for internal, personal, non-commercial purposes; and (c) to reproduce discrete information transmitted by electronic communications solely for internal, personal, non-commercial purposes and provided that you maintain all copyright and other policies contained therein. No print out or electronic version of any part of the UBSDM’s electronic communications or their contents may be used by you in any litigation or arbitration matter whatsoever under any circumstances.
Restrictions and Prohibitions on Use
Your license for participation with UBSDM electronic communications and any information, materials or documents (collectively defined as “Content and Materials”) therein are subject to the following restrictions and prohibitions on use: You may not (a) copy, print (except for the express limited purpose permitted by the “Limited License; Permitted Uses” section above), republish, display, distribute, transmit, sell, rent, lease, loan or otherwise make available in any form or by any means all or any portion of the UBSDM electronic communications or any Content and Materials retrieved therefrom; (b) use any materials obtained via the UBSDM electronic communications to develop, of as a component of, any information, storage and retrieval system, database, information base, or similar resource (in any media now existing or hereafter developed), that is offered for commercial distribution of any kind, including through sale, license, lease, rental, subscription, or any other commercial distribution mechanism.
Information Does Not Constitute Dental/Medical Advice
The UBSDM assumes no responsibility for how you use the information you obtain from the UBSDM via electronic communications. You should consult with your dental care provider regarding your own condition and how the content of electronic communications from the UBSDM may or may not apply to you. Electronic communications are not a substitute for appropriate and timely contact with your health care provider. You should never change or stop any course of treatment prescribed by your health care provider without first consulting him or her.
Acceptance of Agreement
By opting in to electronic communications with the UBSDM, you agree to the terms and conditions outlined in this Terms of Use Agreement for Electronic Communications ("Agreement"). This Agreement constitutes the entire and only agreement between us and you, and supersedes all prior or contemporaneous agreements, representations, warranties and understandings with respect to electronic communications, the content, products or services provided by or through electronic communications, and the subject matter of this Agreement, except for any Authorizations for Release of Health Information that are currently on file or any Authorizations for Release of Health Information that may be executed in the future Authorizations for Release of Health Information are available on the UBSDM website and on the Patient Portal.
This Agreement may be amended at any time by us from time to time without specific notice to you. The latest Agreement will be posted to the UBSDM website, and you should review this Agreement prior to agreeing to electronic communications. The UBSDM does not guarantee the availability, or content completeness or accuracy of its electronic communications. The UBSDM reserves the right to discontinue electronic communications at any time for any reason.
Discrimination is against the law. The University at Buffalo School of Dental Medicine (“SDM”) complies with applicable civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex (consistent with the scope of sex discrimination described at 45 CFR § 92.101(a)(2)). The University at Buffalo School of Dental Medicine does not exclude people or treat them less favorably because of race, color, national origin, age, disability or sex.
The University at Buffalo School of Dental Medicine:
If you believe the University at Buffalo School of Dental Medicine has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with the following offices at the SDM:
University at Buffalo School of Dental Medicine Compliance Office
332 Squire Hall, Buffalo, NY, 14214-8006
Phone: 716-829-2336
Fax: 716-833-3517
Email: sdm-compliance@buffalo.edu
University at Buffalo School of Dental Medicine Office of Equity, Diversity and Inclusion
325N Squire Hall, Buffalo, NY, 14214-8006
Phone: 716-829-2984
Email: jmscates@buffalo.edu
You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, the SDM Compliance Officer, James M. Harris, or the Director of Equity, Diversity and Inclusion Operations, Jessica Scates, are available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal or by mail or phone at:
U.S. Department of Health and Human Service
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, DC 20201
Phone: 1-800-368-1019; 800-537-7697 (TDD)
Complaint forms are available on the Office of Civil Rights website.