Patient Rights Policy
Patient Bill of Rights and Responsibilities
A Patient has the right to:
- Receive all necessary dental care that is available from our office or receive a referral to another provider.
- Considerate, courteous, quality care with respect for personal privacy and human dignity.
- Information concerning his/her diagnosis, treatment, and prognosis (i.e., clear concise communication from our staff, access to his/her medical records in compliance with the law).
- Involvement In the decision-making concerning his/her treatment (i.e., giving informed consent prior to treatment, right to refuse treatment to the extent permitted by law).
- Confidentiality of information concerning one’s treatment.
- File a grievance and be given due process.
If you are unable to resolve the issue with the Practice Manager, you may send a written grievance to:
Attn: Quality Assurance Coordinator
PO Box 423
Germantown, WI 53022
A Patient has the responsibility to:
- Comply with prescribed dental instructions from our office.
- Provide accurate past and present information to our office.
- Keep appointments for care and give required 48 hours’ notice to our office when canceling appointments.
- Maintain his/her health and participate in the decisions concerning treatment.
- Ask questions of the provider if he/she doesn’t understand.
- Make payments due for services received according to established terms.
- Inform his/her provider about any living will; medical power of attorney, and or other directive that could affect his/her care.