Conditions of Treatment and Patient Rights and Responsibilities

ABOUT THE CLINIC: The 萝莉社Delta Dental of Kansas Dental Hygiene Clinic (the 鈥淐linic鈥�) is a training facility for students enrolled in the dental hygiene program (鈥淪tudent Treatment Providers鈥�). Other 萝莉社 employees and/or contractors who are licensed to provide dental hygiene services may also provide services in the Clinic on a limited basis (鈥淪upervisor鈥�). During your appointment, you may be videotaped or observed by others for supervision and educational purposes. Additionally, Student Treatment Providers present clinical cases during their academic classes. Because of this educational component, please allow 2-4 hours for all appointments.

PATIENT RIGHTS AND RESPONSIBILITIES: At the Clinic, we are committed to providing a safe environment in which each patient entrusted to our care is treated with dignity, respect, and compassion. Likewise, the Clinic expects appropriate, respectful, and responsible behavior from our patients and their visitors. Below is a list of patient rights and responsibilities. If you have any questions about these rights and responsibilities, please contact the Clinic at 316.978.3603. You may take this information sheet with you for future reference.

PLEASE NOTE: The Clinic provides only dental hygiene services. As a dental hygiene clinic, the Clinic offers a limited array of services. After review of your oral health status, your Student Treatment Provider and/or the Supervisor may refer you for services outside of the Clinic. The Clinic reserves the right to refer treatment to external providers if the required treatment is beyond the capabilities of the Clinic. Additionally, it is strongly suggested that you seek regular and routine dental care from a dentist. 

As a patient, you have the right to:

  • Be treated with respect and consideration for your medical, dental, and personal needs.
  • Receive treatment and care without discrimination with regard to race, color, national origin, age, religion, ability, marital status, sex, sexual orientation, and gender identity or express.
  • Be provided, to the degree known, complete and clear information regarding your diagnosis, treatment, prognosis, risks involved in treatment, any alternatives, and costs in order to give informed consent or refuse a course of treatment.
  • Refuse treatment or any procedure or seek a second opinion (at your own expense).
  • Appropriate privacy and confidentiality of your medical records (within the confines of applicable law)
  • Be informed of fees for services or procedures provided.
  • Be treated as a partner in care, participating in goal setting, and planning of treatment.
  • Be provided reasonable continuity of care.
  • Be informed of the right to refuse to participate in any research conducted at the Clinic.
  • Address any grievance to Clinic staff. 

As a patient, you have the responsibility to:

  1. Provide complete and accurate information.  You are required to provide complete and accurate information relating to your medical and dental history, medications, dietary supplements, previous illnesses, hospitalizations, allergies, and current care. You must inform the Clinic immediately and prior to any new services of changes in general health conditions or any unusual discomfort following previous treatment. Failure to provide such information may result in cancellation of an appointment and/or dismissal from the Clinic.
  2. Keep your appointment, arrive timely, or cancel at least 48 hours before the scheduled appointment. You understand that regular attendance is an important aspect of successful treatment. You are responsible for arriving on time for your scheduled appointment. It is recommended that you arrive at least 15 minutes prior to your appointment time. If you arrive late to your scheduled appointment, the Clinic reserves the right to deny and/or reschedule treatment. Please be advised that any rescheduled appointment may or may not be with your original Student Treatment Provider. Failure to keep and/or cancel an appointment at least 48 hours in advance will be classified as a 鈥渕issed appointment.鈥� You may be required to pay the fees associated with all missed appointments.
  3. Pay for services when rendered. You are responsible for paying all fees associated with services rendered at the time they are due. If more than one appointment is needed to complete treatment, payment is expected at the first appointment. The Clinic does not accept insurance, but can provide an itemized receipt if requested. The Clinic accepts cash, checks, or credit/debit cards. In the event of failure to pay fees, your name, address, and phone number may be forwarded to a university-approved collection agency in accordance with State of Kansas policies and procedures. Failure to pay all fees when due may result in your dismissal from the Clinic.
  4. Comply with your treatment plan. Your Student Treatment Provider, in conjunction with the Supervisor, will develop a treatment plan that outlines the services to be provided, as well as the required and/or recommended practices that you as the patient will be asked to implement. You are required to cooperate, participate and follow the treatment plan as recommended. Failure to comply with all aspects of your treatment plan may result in dismissal from the Clinic. You accept full personal responsibility for failure to follow the treatment plan. The Clinic is not responsible for any consequences should you refuse to follow the treatment plan and/or fail to follow Clinic instructions and/or advice.
  5. Ask questions. Ask sufficient questions to ensure appropriate comprehension of your dental problems, as well as the proposed treatment plan. If you do not understand something about your treatment plan and/or the services being provided and/or recommended, it is your responsibility to ask clarifying questions to your Student Treatment Provider and/or the Supervisor.
  6. Inform the Clinic of any issues with latex. The Clinic is not a latex-free environment. If you have issues with latex, including but not limited to an allergy you must inform reception staff immediately, as well as your Student Treatment Provider and the Supervisor. For your safety, your appointment may be cancelled if your situation cannot be accommodated. 
  7. Be accompanied by a parent and/or legal guardian or their designee (if a minor). This parent and/or legal guardian (or their designee) must be present during the entire appointment. Parents and/or legal guardians (or their designees) are welcome in the treatment area, although there may be times that we ask that that they wait in the reception area unless specifically requested to enter the treatment area by a Student Treatment Provider and/or Supervisor.
  8. Provide a responsible adult to transport you home and remain with you as required by your treatment provider, if necessary. The Clinic uses local anesthetic agents and nitrous oxide. Should you feel you need assistance with transportation, you are responsible for arranging transportation home from the Clinic. 
  9. Understand that the Clinic is a teaching facility. Because the Clinic is a teaching facility, your Student Treatment Provider may perform services and procedures that you otherwise might not undergo at a private dental practice. These additional services and procedures include, but are not limited to: taking blood pressure and vital signs; exposing radiographs (radiographs); charting periodontal pocket depths; completing intraoral and extraoral examinations; using a disclosing agent; scaling teeth; polishing teeth; examination and evaluation by the dental hygiene faculty before, during and after treatment, application of sealants, fluoride agents, and chemotherapeutic agents; ultrasonic scaling; provision of non-surgical periodontal therapy; air-abrasion polishing; administration of local anesthetic agents and nitrous oxide sedation; tobacco cessation counseling; dietary counseling for caries control; removal of amalgam margins and amalgam polishing. You agree to undergo these additional services and/or procedures as recommended by your Student Treatment Provider and the Supervisor.
  10. Treat Clinic staff and other patients with respect, consideration, and dignity. You are expected to respect the rights of other patients and Clinic staff. It is your responsibility to conduct yourself (and any other individuals that accompany you to your appointment) in a manner that is respectful of other patients and the Clinic staff, including Student Treatment Providers. Failure to do so may result in cancellation of your appointment and/or dismissal from the Clinic.
  11. Comply with all 萝莉社and Clinic policies and procedures. Failure to follow any of these policies and/or procedures, including these Conditions of Treatment, may result in your immediately dismissal from the Clinic. A copy of 萝莉社 University policies and procedures can be found here: /about/policy/index.php. For more information, please ask your Student Treatment Provider and/or the Supervisor.

萝莉社 University
Dental Hygiene Department
Standards of Care

The Dental Hygiene Program has established Standards of Care that serve as the basis for patient care that is delivered in the Dental Hygiene Clinic.  The standards are:

  1. All patients are offered comprehensive dental hygiene care including assessment, dental hygiene diagnosis, a dental hygiene treatment plan, dental  hygiene treatment and examination by a dentist.
  2. Dental hygiene care will be provided in a sequenced and timely manner.
  3. An individualized prevention plan will be developed and implemented for each patient and monitored for effectiveness.
  4. Patients will receive high quality dental hygiene care.
  5. Patients will be satisfied with the dental hygiene care they receive.