5.2 - Patient Management

All prospective patients are required to receive a screening assessment in Oral Diagnosis to determine their suitability as patients in the clinical program. After a preliminary evaluation of the medical/dental history and status, they will either be provisionally accepted, rejected, or referred based on an assessment of many factors, including potential value to the teaching program, ability to pay for treatment, availability for regular appointments, the ability of dental students to provide necessary care, etc. 

The purpose of the screening assessment is to select suitable patients for treatment and to provide the student with diagnostic experiences. The student dialogue with the patient during initial screening is critical to the patient’s understanding and acceptance of the program and its parameters. 

Accepted patients sign the Terms of Participation Form and are placed in the unassigned patient file to await future assignments and periodic review for appropriateness in meeting the clinical experiential needs of students. The assignments are made by the Assistant Dean of Clinical Affairs based on the requests of the Group Practice Directors and the Assistant Group Practice Directors. 

DS2 Faculty Advisor: Professor, Department of Diagnostic & Preventive Sciences

DS3 / DS4 Faculty Advisor: Group Practice Directors Division of Comprehensive Care

Shillingburg Clinic 1
Shillingburg Clinic 2
Shillingburg Clinic 3

Miranda Clinic 1
Miranda Clinic 2
Miranda Clinic 3

Robertson Clinic 1
Robertson Clinic 2
Robertson Clinic 3

The College of Dentistry, as a teaching institution, is strongly committed to providing its students with the best educational experience possible and as such, makes every effort to provide patients for students that offer a wide range of clinical experiences.  More importantly, the College is also committed to providing its patients with comprehensive care that is patient-centered and affordable.

Patients are accepted based on their educational value and assigned to students based on the student’s educational requirements.  There may be instances when an assigned patient does not exactly match the assignment request made by the student; this is unavoidable as treatment needs and the patient’s treatment expectations are subject to change with time.

Students are expected to act with professionalism, responsibility, and accountability in accepting patient assignments; repeated complications in the assignment process with a particular student will ultimately result in the student becoming responsible for procuring his/ her own patients for treatment.

Patients are screened in the Oral Diagnosis Clinic. This clinic is staffed by faculty and assigned students who are on an oral diagnosis rotation (see Section 5.1.2.4: Clinic Schedules). All patients, when completing the screening process, may be recommended for the student clinic, the Advanced Education in General Dentistry program, or may be rejected for our school programs. 

Common reasons for rejection from the student clinics are a case may be too complex for a student or other reasons that may make it difficult to deliver the dental care required.

During the assessment examination, key factors are entered into the axiUm record to categorize the patient’s dental needs. Once the examination is complete and the patient has been provisionally accepted into the program, the assessment information is provided to the Assistant Dean of Clinical Affairs.

On a bi-weekly basis, these patients are assigned to the Group Practice Directors. Senior patient assignments are made by the Group Practice Director to his/her students via the Communications Center. Junior patient assignments are made by faculty designated to either Miranda, Robertson, or Shillingburg Clinic. Sophomore patients are assigned by the Sophomore faculty designated for assignments.

While students are on scheduled rotation in the Oral Diagnosis clinic, they may screen a patient whose needs match their clinical requirements. A request for a specific assignment of a patient, who a student has personally screened, may be submitted to the Assistant Dean of Clinical Affairs; however, there is no agreement that the patient will be assigned to the requested student. Students are not to make promises to any patient regarding when or to whom the assignment will be made.

A student may personally screen and request assignments from family members, friends, or relatives of patients already in their patient family.  Such assignment requests will usually be honored, provided the patient’s dental needs meet the student’s level of ability.  

Once a patient assignment has been made by the Group Practice Director or DS2 Faculty Advisor, the patient’s information is referred to the Communications Center for entry of the assignment and scheduling of the initial workup appointment.

The Patient Services Coordinator (PSC) is responsible for running and maintaining the dental hygiene recall program. The PSC schedules recall patient appointments to available hygiene students' schedules.

All assigned dental hygiene patients (new patients or recall) will remain in the care of the assigned dental hygiene student until transferred to another student or released from the program.  The new patient assignment type DH to Comprehensive Care, requires the PSC to notify the Director of Comprehensive Care once the dental hygiene treatment has been completed for assignment to a dental student.

 A.    DH - Patients whose first experience in the College of Dentistry is in the Dental Hygiene student clinic. These patients will have a dental examination in conjunction with their first round of dental hygiene treatment. They are required to have an exam every 13 months with subsequent dental hygiene treatment. Upon examination, there are 3 possible outcomes:

         1.) No treatment is needed.
         2.) Limited treatment is needed.
         3.) Comprehensive care is needed.

 If limited treatment is needed, the examining dentist will complete a limited treatment form, which will be sent to the Quality Assurance Coordinator. If comprehensive care is needed, (4 or more procedures and comprehensive treatment planning) the examining dentist will send a limited treatment form to the Quality Assurance Coordinator that states full assignment is needed.

 B.     Recall – Patients who have completed their restorative treatment at the College of Dentistry and have been placed on recall or are in the Dental Hygiene Only recall system.

 C.     Comprehensive Care Clinic – Fourth-year dental students assigned to comprehensive care clinics will coordinate the periodontal recall needs of a limited number of their assigned patients with the GPD and the PSCs, for the DH collaboration. The patient is then assigned to a vertical team second-year dental hygiene student for periodontal treatment. The DH and DS student collaborate on the patient’s appointment needs and necessary radiographs.

 D.      Dental Students - Dental students may be seen as patients up to two times per semester. They may only be scheduled to fill in a last-minute cancellation or no-show unless the student has a dental emergency. Dental students may not be scheduled in advance and will not be added to your patient family.  Please see your clinical instructor if you have a no-show or last-minute cancellation and need a last-minute appointment with a dental student.

The DH Patient Services Coordinator (PSC) is responsible for scheduling dental hygiene appointments for their patients.  The PSC, in the clinic in which the patient is seen for treatment, will collect payment for services rendered and schedule subsequent appointments.

Should the patient call the student to reschedule an appointment, it will be managed by the student and communicated to the DH PSC. If a patient has already had two rescheduled appointments, the PSC will determine whether to send the patient a pending release letter or a release letter regarding scheduling difficulties.

Students, along with the PSC, should utilize their patient list to fill appointments that other patients have canceled.

The student is responsible for managing the need for antibiotic pre-medication for their patients. This will not be managed by the Patient Services Coordinator (PSC).

Dental Hygiene Students:

Family members and friends may be seen as personal patients. Contact Dental Hygiene PSC (via amail) to have a personal patient registered into axiUm.  Include the:

• Patient’s name
• Date of birth
• Address
• Email
• Best daytime contact number

Be sure to make it clear that you are a dental hygiene student by placing “DH1” or “DH2” after your name at the end of the message. The subject line should say “DH Personal Patient Request”. Personal patients should be utilized to fill open appointment times or cancellations.

If it is determined that a patient needs to be seen for urgent care (between appointments), the patient should be instructed to contact the DH Patient Services Coordinator.  The PSC will review the case and consult with the Director of Patient Relations on the best course of action for managing the patient’s dental situation. If a limited treatment assignment is deemed necessary, the Director of Patient Relations will complete a limited treatment form for dental student assignments. If a dentist has examined the area of dental concern, he/she should complete a limited treatment form and send it to the Quality Assurance Coordinator, via the axiUm “running man”, instead of having the patient contact the Communications Center.

During non-business hours, patients should be instructed to call 405-271-7744, where they will receive a recorded message with a phone number to contact the AEGD resident who is on call.

The management of pediatric/orthodontic patients is addressed through the Departments of Pediatric Dentistry and Orthodontics and is provided in their clinic manual.

Definitions:

Recruited patients: prospective patients recruited through social media whom students do not know personally.

Personal Patients: are family members, friends, or relatives of patients already in the student’s patient family.

The Director of Development and External Relations for the College of Dentistry will periodically create a patient recruitment message/advertisement for COD's social media accounts. Once this message is posted, students may share it only on their personal Facebook page, Twitter, and/or Instagram with a personalized message.

This recruitment message may NOT be posted to Oklahoma City (or any other city/town) Garage Sale, Facebook Marketplace, Craig’s List, Snapchat, or neighborhood pages.

It is a HIPPA violation to have the prospective patient give their contact information on social media in relation to becoming a patient at the COD. Recruited prospective patients should be directed to the COD website to complete the secure Prospective Patient form. The prospective patient can also be contacted by phone to gather their contact information. Do not ask the prospective patient to give you any information on social media.

Recruited prospective patients should be instructed to go to the COD website (dentistry.ouhsc.edu) to submit the Prospective Patient Form. Within the form, prospective patients can type the student’s name who has recruited them. This will be noted by the Communications Center in the axiUm record so the patient will be assigned to the student if the case difficulty is a match for that student’s academic level. Only prospective patients who meet the program requirements will be scheduled for a screening/assessment.

Students may request to screen people, which they know personally, as their personal patients, in the following manner:

·      DSs amail the Communications Center and DHs amail the DH PSC with the following information:

• My name is                                    and I am a DS     (or DH   ).
• I am requesting the following pt. be scheduled for a screening/assessment as my personal patient.
• Prospective Patient’s Name
• Prospective Patient’s phone number:
• Prospective Patient’s full address:
• Prospective Patient’s birthdate:

·      DH1 and DH2 students may screen/assess their personal patients in the DH Clinic
·      DS2 and DS3 students must have their personal patients screened/assessed in OD
·      DS4 students must screen/assess their personal patients in their Comp Care Clinic

Students must uphold the Student Professionalism Policy (3.14 in the Student Handbook) when managing their Facebook page.

After the patients have been assigned to the students, the protocol for scheduling an appointment is as follows:

DS2s and DS3s

1. The initial appointment is made by the Communication Center. 
2. The subsequent appointments are made by the Communication Center by utilizing the planner or by the PSC at the time of checkout.

DS4s

1. The initial appointment is made by the Communication Center. After the first attempt, the PSC follows up to make the initial appointment.
2. The subsequent appointments are made by the PSC at the time of checkout or by utilizing the DS4 planner.

DH1s and DH2s

1. The initial appointment is made by the DH PSC.
2. The subsequent appointments are made by the DH PSC at the time of checkout or by utilizing the DH planner.

Students are encouraged to be proactive in coordinating the scheduling of their patient family. Initial interactions with patients will determine the success or failure of all subsequent patient relations. Patient confidence and trust will be reflected in their first impressions of the student and the perception of the student’s interest in their needs.

1. Students are encouraged to call the patient as soon as possible (preferably within 24 to 48 hours of the assignment) from a phone within the COD.
   • When contacting a patient to confirm an appointment, the COD highly recommends that COD faculty, staff, and students use a COD telephone located on COD premises, instead of a personal telephone/mobile phone or electronic device. Telephones have been placed near workstations for COD faculty, staff, and students to have access to the COD electronic health record (EHR) for updating Medical Histories or entering notes into patient records. For students, see section 5.2.5.1: COD Phones for Student Use in COD Student Handbook for phone locations. See Contacting Patient by Phone HIPAA Policy. 
2. The student should call at reasonable hours. If the student needs to contact a patient in the evening, they should do so by 8:00 p.m.  Calling very late at night or early in the morning is discouraged. Elderly patients should be called relatively early in the evening.
3. Texting- Texting protected health information (PHI) is unacceptable. Texting a patient is not recommended. If the patient insists on receiving text messages, the student should always confirm the consent of the patient to receive text messages by reviewing the Request and Consent for Electronic Communication (ELCON). The patient may only receive text messages to the cell number indicated on the ELCON. If an ELCON is not on file or expired, a text message cannot be sent until the patient completes and signs a new ELCON for text messages at their next appointment.
4. If someone other than the patient answers the phone, the student should find out when the patient will be available and call again.  It is appropriate to leave a message to have the patient return the call by stating you are from the COD and leaving a return phone number. Do not divulge any information regarding the patient's past or upcoming treatment or appointment times to anyone not listed on the Authorization to Release PHI Verbally to Others form. Do not assume that the message will be forwarded to the patient.
5. The student should identify themselves once the patient is reached and state the reason for their call. The patient should be asked if they are still interested in being treated at the College of Dentistry.
6. The student should avoid identifying their class status and they should spell their name, if necessary. Patients often call the College of Dentistry and give a distorted or garbled version of a name which can make it difficult to identify the student.
7. Students should remind their patients to review the information in their copy of the “Terms of Participation” form (required availability for appointments, payment policies, etc.) and remind them that appointments will be 2-3 hours in length.
8. All scheduled patient appointments should be confirmed by the student the evening before. This is a helpful reminder to the patient and allows the student an opportunity to contact another patient if the original patient must reschedule.
9. At the end of the clinic appointment, the student should have a future planned procedure code and arrange their patient's next appointment, by checking the patient out with their PSC.
10. If a particularly involved or complex procedure was performed, the student should call their patient, before leaving the COD that day, to inquire about the patient's well-being. 

IMPORTANT! Record all phone contact attempts in the electronic record in the Patient Contact Notes section, including the number called.

The University of Oklahoma College of Dentistry will take all necessary steps to protect and safeguard patients’ Protected Health Information (PHI). Students should review the Contacting Patient by Phone or Electronic Devices Policy prior to calling, texting, or emailing patients. Failure to do so could result in HIPAA violations and sanctions.

The COD highly recommends using a phone located within the COD for calling patients instead of their personal phone. Phones have been intentionally placed near workstations, so students have access to axiUm for updating Health Histories or entering notes. Locations of phones available for student use are listed below:

Student Lounge

• Four (4) wall-mounted phones
• Always available

Radiology Viewing Room

• Four (4) wall-mounted phones
• Available Monday-Friday during normal business hours and after hours with card access.

Comprehensive Care Faculty Offices

• Available during non-clinic hours

Fourth Floor Faculty Offices

• Available during non-clinic hours

Phones can be used to make outside calls by dialing “9” plus the number. The caller ID will state “Health Care 405-271-8001”.  These phones can also be used to dial an extension on the OUHSC campus.

Note: voicemail is not activated on phones. 

Additional resources:

Contacting Patient by Phone or Electronic Devices Policy

Safeguards – Administrative and Physical

Emailing and Transmitting PHI

If a patient needs to be referred to the Graduate Periodontics Program to be seen by a resident, the examining dentist completes a referral form in axiUm and sends it to the Grad Perio staff (via axiUm running man).

Should you have a patient who needs to be referred to OMS/Oral Surgery Program to be seen by a resident,  the examining dentist completes an OMS Referral form in axiUm, and hand delivers it to the OMS resident clinic staff.

This electronic form provides the patient with information regarding patient acceptance, appointment availability, financial responsibility, follow-up care in dental hygiene recall, and eligibility for further treatment at the College of Dentistry. The consent form must be signed by the patient (or the patient's parent/guardian if a minor child) and a printed copy is given to the patient for their records. This confirms an understanding and acceptance of the responsibilities of participation in the student program at the College of Dentistry.

Informed consent is an important legal concept that protects the student and the College of Dentistry against any allegation that work was performed without permission. To ensure that informed consent is fully secure, the patient must be made aware of:

    1.  the nature of the existing medical/dental condition to be treated
    2.  prognosis of the condition, if left untreated
    3.  any or all risks involved with treatment
    4.  alternative methods of treatment
    5.  reasons for any subsequent changes in treatment.

The patient will also be required to sign the College of Dentistry’s Payment Policy which outlines the financial responsibilities of the patient and a statement regarding fee reductions for pediatric patients based on income level.  The patient may receive a printed copy of this form upon request for their records.

A patient accepted for emergency care or limited treatment is also required to sign a statement of understanding of the parameters under which care is being rendered.  It is the student's responsibility to ensure that all appropriate documents relating to informed consent are complete, signed, and made a permanent part of the patient's record.

These electronic documents are found within axiUm.

Provides the patient with information regarding the risks and benefits of Comprehensive Care, Local Anesthesia, Periodontal Treatment, and Restorative Treatment, in addition to the consequences of no treatment. This consent is to be signed before any treatment is provided.

The Master Treatment Plan (MTP) is the document, in the electronic record, of all planned treatments developed after departmental routing, specialty faculty consultation, or by other authorized individuals, such as Group Practice Directors.  This document, in addition to the signed predoc consent to treatment (PDPC), gives consent to the treatment listed. It is also a key element to utilize for providing a finance plan. The Master Treatment Plan and the Patient Consent to Treatment Form require the patient’s electronic signature.

Master Treatment Plans may be changed during treatment. Every time a change is made to the master treatment plan, the patient must sign a revised treatment plan. There are times when a master treatment plan may not be completed prior to the delivery of dental care to the patient. However, there must be a signed consent to treatment and a signed treatment plan for the procedures that will be completed prior to the completion of the master treatment plan.  Examples include delivering emergency care or starting periodontal treatment prior to the completion of the treatment plan.

Treating a patient without a signed PDPC and treatment plan is a serious recordkeeping omission. 

The Americans with Disabilities Act (ADA) provides for the protection of service animals for disabled people.  Service animals are working animals, not pets.  We welcome patients who require a service dog that is individually trained to do work or perform tasks for a person with a disability.  The task(s) performed by the dog must be related to the person’s disability.  If the patient has a service dog that falls under Titles II and III of the Americans with Disabilities Act (ADA), they can bring the dog with them to all areas of the clinic where the public is allowed to go.  It may be proper to exclude a service animal from surgical areas where the animal’s presence may compromise a sterile environment. 

The service animal must be harnessed, leashed, or tethered while in public places unless these devices interfere with the service animal's work or the person's disability prevents the use of these devices. A person may be asked to remove their service animal from the premises if: (1) the dog is out of control and the handler does not take effective action to control it or (2) the dog is not housebroken.  When there is a legitimate reason to ask that a service animal be removed, staff must offer the person with the disability the opportunity to obtain goods or services without the animal’s presence.  

Examples of service animals that must be allowed into public accommodations under the ADA include:

• Hearing dogs - alert their handlers to important sounds, such as alarms, doorbells, and other signals
• Guide dogs - help those who are blind or visually impaired navigate safely
• Psychiatric service animals - help their handlers manage mental and emotional disabilities by, for example, interrupting self-harming behaviors, reminding handlers to take medication, checking spaces for intruders, or supplying calming pressure during anxiety or panic attacks
• Seizure alert animals - alert their handlers of impending seizures, and may also guard their handlers during seizure activity
• Allergen alert animals - alert their handlers of foods or other substances that could be dangerous (such as peanuts).

If it is not apparent what the service animal does, we may ask only whether it is a service animal (we can ask if the dog is required because of a disability), and what tasks has the dog been trained to do. We may not ask what the person’s disability is and we may not request the provision of any service animal training certification or other proof of training.

If the animal does not perform a service but provides emotional support, therapy, comfort, or companionship, they are not allowed in the building. Dogs whose sole function is to provide comfort or emotional support do NOT qualify as service animals under the ADA.

Oklahoma City Clinics

During Clinic Sessions:

1.  The patient contacts either the Communication Center or the PSC and reports their dental concern.
2.  The dental concern is recorded in the contact notes of the patient’s electronic health record.
3.  The assigned student’s schedule is reviewed for open appointments.
4.  If the student is unavailable due to a rotation, the scheduler looks for another student in the same class and group practice who has an opening.
5.  If that is unsuccessful, the scheduler moves to the schedule of an adjacent group practice for an available student with whom to schedule the patient.
6.  If someone other than the assigned student sees the patient, an amail should be sent to the assigned student informing him/her of what transpired with the patient.

After Hours:

1.  The patient calls the main phone number 405-271-7744 and is given a number to call for the AEGD on-call resident.
2.  Upon receipt of being contacted, the resident contacts the patient to determine the nature of the dental concern and obtains the patient’s name, DOB, and assigned student’s name.
3.  The resident provides feedback to the patient regarding the dental concern and may determine that it is appropriate to call in a prescription for the patient.
4.  The resident amails the Director of Patient Relations, the Director of AEGD, and the student provider and records the following information in the patient EHR to report the management of the patient including:

• Patient instructions/information
• Follow-up care indicated
• Details of any prescriptions called in, including
  • Drug name
  • Dosage
  • Quantity
  • Pharmacy information including name, location, and phone number where the prescription was sent.

The student provider of the patient provides necessary follow-up.

During Academic Break:

1. The patient calls the Communications Center and reports their dental concern.
2. The Communications Center determines the urgency of the need by either referring the patient to AEGD to schedule an urgent appointment or scheduling the patient with the assigned student in the first available appointment session when the student returns. The Communications Center staff enters a contact note recording the patient’s dental concern.
3. If the choice is to schedule with AEGD, a referral is completed by Communications Center staff and forwarded to AEGD for scheduling.
4. The treating resident sends an amail to the assigned student, the Director of AEGD, and the Director of Patient Relations informing them of what transpired with the patient. 

Tulsa Clinic

During Clinic Session: Follow the same protocol as the OUHSC campus with the exception that the patient calls the Tulsa Clinic directly.

After Hours: 

1. The patient of record calls the Tulsa clinic and is directed to call AEGD for the on-call resident.
2. The resident triages the call and determines if the patient needs to be seen in the Tulsa Clinic. 
3. The resident contacts the on-call dentist regarding the emergency. 

During Academic Break: 

1. The patient of record calls the Tulsa clinic and the PSC or dental assistant will manage the emergency.  
2. The PSC or dental assistant will contact the Tulsa on-call dentist and an available dental student if the patient needs to be seen.  
3. The PSC or dental assistant will schedule the patient in the designated emergency chairs by utilizing axiUm.  
4. It is ideal that the patient be treated in the Tulsa clinic, but if no one is available, the patient will be directed to the AEGD clinic at the COD for care. 
5. If the patient needs to be seen at the COD, the treating resident will send an amail to the AEGD Director, the Tulsa Clinic Director, the assigned dental student, and the Director of Patient Relations informing them of what transpired with the patient.

1. The Communication Center will assign this patient to an available fourth-year student with an opening in their schedule.
2. After the emergency has been taken care of, the patient is scheduled for the appropriate completion of treatment.
3. Once the emergency treatment has been completed, the patient has the option to be screened for comprehensive care with the completion of the online Prospective Patient Form.

During Clinic Sessions

• The same protocol for the adult patient is followed with the exception that the student is responsible for contacting the parent to determine the nature and urgency of the emergency.  We consider this to be part of the teaching/learning experience -- discovering what is and what is not a true dental emergency. 
• If the situation is such that the patient needs to be seen before the assigned student can see the patient, then said patient will be scheduled either into the Pedo restorative rotation clinic or with another student. 
• If circumstances dictate, a prescription may be sent in.
• If the urgency/emergency can be managed without an immediate visit, the patient will be scheduled/added to the assigned student’s appointment list.  

After Hours

• The Pedo faculty should be contacted regarding how to address the particular patient's situation. 

During Academic Break

1. The patient’s parent or guardian contacts the Pedo PSC or PCM. They will determine the urgency of the need after consulting with the Pedo faculty. 
2. A referral is completed by Pedo PSC or PCM staff and forwarded to AEGD (or GPR program director if the patient is covered by SoonerCare).
   • If the referral is to the GPR program director, the Pedo PSC or PCM calls the GPR scheduler, ext. 14750, to alert that a referral has been sent through axiUm. 
3. The program, to which the patient was referred, will call the parent or guardian to schedule the patient.  
4. After treatment, the treating resident will send an amail to the AEGD Director or GPR Director (depending on which clinic treated the patient), the assigned dental student and the Director of Patient Relations informing them of what transpired with the patient.

In addition to completing minimum clinical experiences for graduation consideration, the student must also reconcile all assigned patients including all those initially assigned for complete treatment, patients accepted as a transfer, and patients provided limited care. Reconciliation involves planning the process for continued care (or removal from the program) prior to graduation and is expected of every student to complete the graduation sign-out process.

There are four methods for patient reconciliation:

1. Completion of Treatment
2. Transfer to Another Student
3. Patient Release
4. Completion of Limited Care

Completion of patient treatment is the most desirable method of patient reconciliation, and it is, therefore, highly recommended that students make patient assignment requests based on their ability to manage the patient’s care until completed. If a student requires counseling regarding their ability to manage their patient family, an appointment should be made with their faculty advisor.

Release involves the removal of a patient from the program and the discontinuation of treatment. This action will only be implemented for legitimate causes including (but not limited to):

• Inability to pay for treatment
• Lack of interest in the program
• Unwillingness to accept treatment recommendations
• Moving out of the area
• Three or more cancellations and/or failed appointments
• Severe behavioral management problems
• Unavailability for regular appointments
• Formal referral to a collection agency
• The patient requested to discontinue treatment
• Treatment not within the scope of the program – too complex

It is not acceptable to release a patient because of race, sex, age, or occupation.

It is also not acceptable to deliberately neglect a patient whose needs do not coincide with your expectations or academic requirements. Patient neglect is a punishable offense and will be discussed in the Patient Abandonment, section 5.2.10.3.

Never confront a patient with release without justifiable cause. To request release, see your Group Practice Director and PSC. A patient should never be confronted with dismissal unless the student has sufficient evidence that a valid reason exists. Always consult with the Director of Patient Relations before you consider these actions and certainly before the patient is informed.

The release of patients from the predoctoral program must be accompanied by proper documentation, which should include any information that may affect the future interactions of both the student and the College of Dentistry with the patient (financial difficulties, scheduling conflicts, unwillingness to accept planned treatment, mutual agreements to defer treatment, lengthy unavailability for treatment, etc.). Questionable patient releases require authorization from the Director of Patient Relations.

A single canceled or missed appointment is not reasonable grounds for release. While patients must be available at least two half-days per week, students will seldom see any patients more than once a week. If a patient is only available outside the normal clinical patient expectations, this may not be grounds for dismissal provided that their schedule coincides with the current available clinic time. The student should be reasonable and flexible with their expectations or the patient should be reassigned to a student who has clinic time available when the patient is available.

It is extremely important that the student establish authority regarding the College of Dentistry policies early in the relationship. Therefore, the student should be very familiar with the information in this manual and should be able to respond to questions regarding school policies. The student should tactfully dictate the frequency of appointments, determine treatment sequencing, and inform the patient when their actions may jeopardize their status in the program (frequent cancellations/no-shows, failure to pay account balance, etc.)

A patient referred to the College’s collection agency is automatically released even if you have not requested this action. You will not have access to any electronic record in collections without the permission of the Central Billing Office.

A patient may request reactivation if the reasons for the original release no longer apply. Reactivation of a patient referred to a collection agency will not be allowed. The Director of Patient Relations must approve all reactivation of released patients.

Infrequently, a patient may be notified through a letter of pending release regarding the nature of one of the above-listed problems that may be the cause for release if the circumstance does not change. Patients are given 2 weeks (10 business days) to appeal the release, if no response is received, the patient is processed for the final release.

Dental students may request an assignment of a Limited Care patient at any time by electronic submission. Limited Care Patient Requests are to be submitted electronically to the Director or Patient Relations. While assignment requests will be filled in the order they are received, there may be times when a request that is too specific will delay the process and other requests will be considered for assignment in the interim.

Additional considerations regarding the assignment:

• Students must have a Limited Treatment request on file for assignment.
• Students will be allowed 2 (two) Limited Treatment patients in their patient family.
• Students will not be assigned another patient until treatment is resolved on the previous patients assigned to them.
• Students must complete all Limited Treatment assignments. Patients will not be re-assigned.

Once the student has accepted a Limited Care patient, they are responsible for every procedure specified on the form including any required follow-up care.  Limited Care patients may be taken directly to the proper clinic(s) for treatment or consultation as necessary; a work-up and treatment planning is not needed unless requested by consulting faculty. The Workflow for Limited Treatment Patients can be found in the Clinic Binder in each clinic faculty office. The “official” Clinic Binder is now available in axiUm. The location is axiUm/Links/Clinic Binder.

Abandonment - a unilateral termination of the patient-physician relationship by the physician without notice to the patient.

The relationship between physician and patient generally continues until it is terminated by mutual consent of both parties.  However, a relationship can be discontinued through the dismissal of the physician by the patient, the physician's withdrawal from the case, or the physician’s services are no longer required.  Failure to follow up on patient care after the acute stage of illness has subsided or neglect to give patient warnings of necessary instructions may involve the physician in serious legal difficulties.  Premature termination of treatment is quite often the subject of legal action.

Closely related to this type of problem is one which occurs when the physician, though not intending to end the relationship with the patient, fails to ensure the patient’s understanding that further treatment of the complaint is necessary.

The following elements must be present for a patient to recover damages for abandonment:

1. Unreasonable discontinuance of medical care.
2. Discontinuance of medical care against the patient’s will: termination of the physician-patient relationship must have been brought about by a unilateral act of the physician. There can be no abandonment if the relationship is terminated by mutual consent or dismissal of the physician by the patient.
3. A physician’s failure to arrange for care by another physician or refusal by a physician to enter a physician-patient relationship by refusing to respond to a call or render treatment is not considered abandonment. A plaintiff will not recover damages unless it can be established that a physician-patient relationship has been established. (i.e., Buttersworth v. Swint, 186 E.E. 770 (Ga. 1936)
4. Foresight that discontinuance may result in physical harm to the patient.
5. Actual harm suffered by the patient.

The relationship between a physician and patient, once established, continues until it is ended by mutual consent of the parties, revoked by the patient’s dismissal of the physician, by the physician’s withdrawal from the case, or until the physician’s services are no longer needed. A physician who decides to withdraw his services must provide the patient with reasonable notice so that the services of another physician can be obtained.

The Director for Quality Assurance and Director for Patient Relations will not tolerate willful abandonment, and has joined the Department of Pediatric Dentistry in establishing the following guidelines to aid in determining if abandonment has occurred:

1. Willful or undocumented failure to see patients with treatment needs within the semester assigned.
2. Failure to see any patient for two consecutive semesters without sufficient documentation in the record to justify such failure to see the patient.

In cases where abandonment has occurred, a grade of “F” will be given for the Clinical Record-Keeping and Patient Management course for the semester during which the incident occurred.

Students may provide dental care to other students under the following conditions:

1. In the event of a cancellation or no-show by a COD patient.  Student-on-student appointments should not be pre-scheduled preventing a COD patient from being scheduled.
2. There is a specified dental need (usually identified by symptoms or examination by a private dentist).
3. Any lab costs incurred are the financial responsibility of the student patient.
4. An appointment must be scheduled in axiUm and all clinic protocols must be followed.
5. Not as comprehensive care with a full workup, but as limited treatment.

Workflow for student-on-student treatment can be found in the Clinic Binder in each clinic faculty office. The “official” Clinic Binder is now available in axiUm. The location is axiUm/Links/Clinic Binder.

Referrals between the predoctoral program and post-graduate programs occur to enhance the continuity of care in situations where the treatment needs of the patient are beyond the limitations of the predoctoral program. This referral process involves the various post-graduate clinics: AEGD, Grad Ortho, Grad Perio, and Oral Surgery as well as the Adult predoctoral program and must be started through consultation by full-time faculty from the referring department. The workflow for the COD Referral process can be found in the Clinic Binder in each clinic faculty office. The “official” Clinic Binder is now available in axiUm. The location is axiUm/Links/Clinic Binder. 

Dental practitioners must complete the Patient Referral for Limited Treatment in Students Clinics form and submit appropriate x-rays to the Quality Assurance Coordinator via email located on the form. This information is reviewed and the patient is assigned to the appropriate student. In the case of endodontic treatment, the assignment is coordinated with the Chair of Endodontics. When patients needing endodontic treatment are assigned to a student, the student will review the case with the Chair of Endodontics before scheduling the patient in the clinic.

If a patient reports a concern they want addressed by the administration, the Director of Patient Relations should be contacted to help reconcile the patient’s concern.