Patient Information

We start with a 20 minute no-cost screening to determine whether or not your needs meet our ability to provide treatment. If accepted as a teaching case, you may continue with the comprehensive exam and radiographs that same day(s) or schedule an appointment at a convenient time.

Throughout your exam, we keep you informed. Findings are reviewed by student and faculty, and then we discuss treatment plan options — carefully explaining the exam results, the anticipated costs, and scheduling.

To ensure the safety of children, they will not be permitted to accompany you into the treatment area or be left unattended in the waiting area. Children must be supervised by another adult in the waiting area at all times. If your children are left unattended, your appointment will be cancelled. Therefore, please make prior arrangements for appropriate childcare.

Appointments should be cancelled only when it is absolutely necessary. Your student doctor will give you the clinic phone number to call directly.

We require 48 hours of notice for an appointment cancellation. If you cancel with less than 48 hours notice of your scheduled appointment, it would be considered a “no show” appointment. Patients who fail three scheduled appointments will be dismissed from the Dental Institute and will not be permitted to continue in the teaching program.

Please remember that your student doctor depends on you to make your appointments as there is a limited amount of time for your student doctor to achieve the necessary clinical experiences required for graduation.

Special Needs

Please advise us in advance if you have a special need such as a hearing impairment or availability of a wheelchair.

Non-English-Speaking Patients

For the benefit of your understanding of the treatment provided, we encourage you to bring a translator with you to your appointment if you do not speak English.

If you have dental insurance, please bring your insurance information with you to your first appointment. This should include a valid insurance card, an address for submitting claims, and the name, date of birth, and identification number of the subscriber. The Midwestern University Dental Institute currently accepts a limited number of dental insurance plans. However, as a courtesy, we will provide a copy of the dental claim form for you to submit to your insurance company for reimbursement once services are paid in full. It is the patients’ responsibility to review their insurance policies regarding any limitations, exclusions, alternative benefits, deductibles, co-payments, annual maximums, and pre-authorizations prior to treatment.

Referrals and Prior Authorizations

Patients are responsible for verifying with your insurance carrier whether you need a referral or prior authorization. If your insurance requires a referral or prior authorization, you must first obtain the referral or prior authorization and bring it to your appointment.

THE DENTAL INSTITUTE IS NOT OBLIGATED TO PROVIDE ANY TYPE OF CARE, COMPREHENSIVE OR LIMITED, WHICH IS NOT IN THE BEST INTEREST OF THE PATIENT ACCORDING TO THE JUDGMENT OF THE CLINICAL FACULTY.

The Dental Institute will attempt to make payment arrangements when necessary. However, if a payment plan has been established and no payment activity has occurred on the patient account, this may result in dismissal from the Dental Institute and other Midwestern University Clinics and the account being sent to a collection agency.

Dental records are the property of the Dental Institute. As the patient, you have a right to view them and have reasonable access. Copies of your records and x-rays will be provided to you or forwarded to another practitioner upon your signed written request. There is a nominal fee charged for the duplication of records.

Records Release Form

The Midwestern University Clinics are committed to providing quality care and service for our patients. As a health sciences university, we also provide training for future healthcare professionals who are supervised by our faculty. As a partner in this educational process, you have the right to:

1. Impartial access to treatment without regard to race, national origin, religion, gender, sexual orientation, age, disability, marital status, or diagnosis.
2. Receive care in a safe setting; be treated with dignity, respect, and consideration; and receive treatment that supports and respects the patient’s individuality, choices, strengths, and abilities.
3. Receive privacy in treatment and care for personal needs, including the right to request to have another person present during certain parts of a physical examination, treatment, or procedure performed by a health professional.
4. Review, upon written request, the patient’s own medical record as set forth in A.R.S. §§ 12-2293, 12-2294, and 12-2294.01 and ask that your doctor amend your record if it is not accurate, relevant, or complete.
5. Receive a referral to another healthcare institution if Midwestern University Clinics are not authorized or not able to provide the required physical or behavioral health services.
6. Participate or have the patient’s healthcare power of attorney/guardian on file participate in the development of or decisions concerning treatment, including an explanation of the prescribed treatment, treatment alternatives, the option to refuse or withdraw consent for treatment before treatment is initiated (except in an emergency), the risk of no treatment, expected outcomes of these treatments, and to be told, in language you can understand, the advantages and disadvantages of each.
7. Participate or refuse to participate in research or experimental treatment.
8. Receive assistance from a family member, the patient’s representative, or other individual in understanding, protecting, or exercising the patient’s rights.
9. Receive accurate and easily understood information about your healthcare professionals and healthcare facilities.
10. Ask for and receive an itemized bill and receive an explanation of your bills.
11. Consent to photographs before a patient is photographed.
12. Receive continuing care by your healthcare provider, under certain circumstances, when your health plan changes and your healthcare provider is not included in the new plan or your healthcare provider terminates the relationship with the healthcare plan.
13. A prompt and reasonable response to any complaint you have against your healthcare provider. This includes complaints about waiting times, operation hours, the actions of healthcare personnel, and the adequacy of healthcare facilities.

1. No patient will be denied treatment based on race, color, religion, national origin, gender, sexual orientation, age, marital status, disability, or public assistance status.
2. The patient shall be treated in a courteous manner, with dignity and respect for the patient’s right to confidentiality.
3. Patients scheduled during the posted operating times will be seen for services as quickly as possible, with assignment, initial treatment where indicated, and follow-up appointments scheduled as soon after the initial screening appointment as is practical.
4. If, during the screening appointment, the supervising faculty dentist determines that the person seeking care will not be accepted as a patient, that person will be immediately informed of the decision.
5. The patient shall have access to emergency, incremental, and comprehensive care as appropriate for the patient’s presenting condition(s).
6. The patient or parent/legal guardian shall receive an explanation of the results of the examination, alternative treatment options, sequence, costs of service, and the option to pursue care elsewhere if dissatisfied with the planned treatment.
7. The patient or parent/legal guardian shall be advised of the risks of the treatment planned, including risks of individual procedures and the consequences of no treatment.
8. The patient shall receive continuity of care and completion of treatment.
9. The patient shall receive care during posted clinic hours or shall receive emergency consultation by phone or, if deemed necessary, treatment at a designated location after regular clinic hours.
10. Treatment shall be supervised by faculty and shall be consistent with the standards of care in the community.
11. The patient shall be seen as soon as possible after the scheduled appointment time and have ongoing treatment rendered in a timely manner.
12. Every patient will receive a copy of the Patient Bill of Rights at the time of service.
13. The patient shall have access to a patient advocate should there be any questions or concerns related to the patient’s treatment.
14. Patients whose treatment is discontinued will be notified in writing. Alternate treatment options may be suggested.
15. At the time of admission as a patient, an individual patient record will be established. This record will contain diagnostic and therapeutic information related to the patient’s care and will be updated at every appointment according to the guidelines of the Midwestern University Clinic Patient Record Protocol.
16. Upon completion of treatment, the Quality Assurance Committee conducts random examinations to determine the completeness, timeliness, and appropriateness of care, the
    patient’s level of satisfaction with care, and the completeness of the patient record. Corrections will be instituted as needed.

It is the policy of Midwestern University to maintain a positive, trusting, and cooperative relationship with clinic patients. In the event a clinic chooses to dismiss a patient of record from the teaching program and/or clinical care, this policy outlines the University’s patient dismissal procedure.

Single Clinic Dismissal

A clinic may decide, independently of another clinic, to dismiss a patient. That patient may be dismissed from the teaching program or from the clinic for any of the following reasons:

1. Need for care or expectations exceed the scope of a teaching program.
2. After three no-show appointments during the preceding twelve calendar months, a patient may be dismissed from the teaching program or clinic. A no-show appointment is defined as the patient’s failure to provide 48-hour notice of cancelation and/or failure to show for scheduled appointments.
3. A patient may be dismissed who is seeking only occasional treatment for relief of pain and not interested in comprehensive care.
4. Failure to schedule appointments for completion of procedures.
5. Failure to schedule health maintenance appointments.
6. Refusal to provide complete and accurate information about current medical conditions and complaints, past illnesses, medications, and other issues relevant to care.
7. Failure to adhere to the Midwestern University Clinics’ responsibilities as a patient or guardian of a patient, as outlined on the clinic website.
8. Refusal of treatment and/or not following provider instructions.
9. Failure to provide information about payment for services.
10. Each clinic may individually make a decision to dismiss a patient. For example, a patient who fulfills criterion 4 may be dismissed from the Dental Institute, but might not be dismissed by the Eye Institute. Final decision for a patient dismissal is made by the Clinical Dean/Medical Director or their designee in each clinic.
11. Patients in the midst of a multi-step procedure may complete their treatment at the discretion of the Clinical Dean/Medical Director and be stable prior to dismissal. A dismissed patient will be allowed emergency care for 30 days from the date of dismissal and will be given a referral to another provider.

All Clinics Dismissal

• A patient who exhibits drug seeking behavior, sexual or other forms of prohibited harassment, and/or use of abusive or derogatory language will be dismissed from all clinics. In the instance where the dismissed patient has animal(s) being seen at the Companion Animal Clinic or Large Animal Clinic, the animal(s) will be dismissed from the clinic(s).
• In the instance that the dismissed patient has a minor child and/or spouse being seen at a clinic, that minor child and/or spouse will be dismissed from the clinic.
• A patient may be dismissed for failure to meet all financial obligations.

Appeal of Dismissal

Patients may appeal their dismissal to the appropriate Clinical Director, the Dean of the College, or their designee for discussion and resolution. The Dean of the College will notify the Chief Academic Officer immediately of patients’ appeal referrals. If the dismissal is upheld, patients are notified that they may appeal to the Chief Academic Officer of the respective college or clinic involved in the dismissal.