Current Patients

We encourage you to learn about your privacy at UB Dental:

1. Understand and use these rights. If, for any reason, you do not understand or need help, the school will provide assistance;
2. Be treated and receive services with dignity and respect, regardless of race, religion, age, disability, gender, beliefs, marital status, lifestyle, sexual orientation, national origin or sponsor;
3. Be informed of the services available at the clinic;
4. Be informed of the provisions for off-hours emergency coverage;
5. Receive treatment in a clean and safe environment, free of unnecessary restraints;
6. Receive emergency, incremental and total care to completion consistent with the standard of care in the profession;
7. Be informed of and receive an estimate of the charges for planned services, view a list of the health plans and the hospitals that the center participates with; eligibility for third-party reimbursements and, when applicable, the availability of free or reduced cost care;
8. Receive an itemized bill, explanation of all charges or statement of account, upon request;
9. Receive an estimate of the amount that you will be billed after services are rendered;
10. Obtain from your health care practitioner, or the health care practitioner’s delegate, complete and current information about the diagnosis, treatment and prognosis in terms you can reasonably be expected to understand;
11. Assistance with non-English-speaking interpreter services;
12. Receive education, counseling and explanations to your questions;
13. Know the names, positions and functions of any personnel involved with your care;
14. Participate in all decisions about your treatment;
15. Receive the information necessary to give informed consent prior to the start of any non-emergency procedure or treatment, or both. An informed consent shall include, as a minimum, the provision of information concerning the specific treatment or procedure, the alternatives to care, the risk of no treatment, the reasonably foreseeable risks and benefits of the treatment and expected outcomes disclosed in a manner permitting you to make a knowledgeable decision;
16. Refuse examination or treatment to the extent permitted by law and be fully informed of the medical consequences to your action;
17. Refuse to take part in experimental research. In deciding whether or not to participate, you have the right to a full explanation;
18. Access to a patient advocate;
19. Voice grievances and recommend changes in policies and services to the University at Buffalo School of Dental Medicine staff, the operator and the New York State Department of Health without fear of reprisal;
20. Express complaints about the care and services provided and have University at Buffalo School of Dental Medicine staff investigate such complaints. The University at Buffalo School of Dental Medicine is responsible for providing a written response within 30 days, if requested, indicating the findings of the investigation. If you are not satisfied, you may complain to the New York State Department of Health;
21. Privacy and confidentially of all information and records pertaining to your treatment;
22. Approve or refuse the release or disclosure of the contents of your medical record to any health care practitioner and or health care facility except as required by law or third-party payment contract;
23. Access to your medical record per Section 18 of the Public Health Law, and Subpart 50-3. For additional information link to: Access to Your Medical Records and Do I Have the Right to See My Medical Records?
24. Review your records with a clinician and obtain a copy of your record for which the School of Dental Medicine can charge a reasonable fee;
25. Designate family members and other adults as authorized representatives to disclose protected health information, upon written authorization. You have the right to impose limits on the disclosures and revoke the authorization at any time, as permitted by law according to the Notice of Privacy Practices;
26. When applicable, make known your wishes in regard to anatomical gifts. Persons sixteen years of age or older may document their consent to donate their organs, eyes and/or tissues upon their death by enrolling in the NYS Donate Life Registry or by documenting their authorization for organ and/or tissue donation in writing in a number of ways (such as health care proxy, will, donor card, or other signed paper). 

REV. 1-12-2024; APPR. CC 4-29-2024

You have a responsibility to:

1. Provide, to the best of your knowledge, accurate and complete information about present medical and dental history, past illnesses, hospitalizations, medications, and other matters relating to your health.  You have the responsibility to report changes in your health status;
2. Follow the treatment plan agreed upon by you and your dental care providers. This may include following instructions of allied dental health personnel as they carry out the coordinated plan;
3. Make known to your dental care provider that you understand and agree to the treatment plan, and that you know what is expected of you;
4. Comply with the rules and regulations of the UB School of Dental Medicine, The State University of New York at Buffalo, and the State of New York;
5. Be on time and available for your appointments (3-4 times per month);
6. Have a working phone number in order for your dental provider to be able to contact you to schedule appointments;
7. Be considerate and respectful of the rights of other patients and UB School of Dental Medicine personnel.  You are responsible for being respectful of the property of other persons and the University at Buffalo. Patients are expected to treat UB faculty, students and staff with courtesy and respect. Inappropriate behavior or comments of a racial, cultural, ethnic or sexual nature will not be tolerated and may result in dismissal as a patient from the School of Dental Medicine;
8. Provide proper childcare while you are being treated at the SDM clinics. Children are not to be left unattended and are not permitted to accompany an adult patient who is receiving treatment;
9. Be escorted into patient treatment areas by your student dentist. No other individual should accompany you into the treatment areas unless medically necessary or approved by the student dentist’s faculty;
10. Pay for service at the time it is provided.                                                          

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:

• By phone: 716-829-2390
• By mail: UB School of Dental Medicine, 325 Squire Hall, Buffalo, NY 14214-8006

Hours are by appointment. You may also contact the New York State Department of Health’s Office of Health Systems Management.

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:

• Provides people with disabilities with reasonable modifications and free appropriate auxiliary aids and services to communicate effectively with us, such as:
  • Qualified sign language interpreters.
  • Written information in other formats (e.g., large print, audio, accessible electronic formats, other formats).
• Provides free language assistance services to people whose primary language is not English. Services may include:
  • Qualified interpreters.
  •  Information written in other languages.

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.