Required Documents for First Visit
To ensure your first visit to the Dental Care Center is as efficient as possible, please complete and bring with you forms from the Program Selection Appointment Packet.
Please be sure to also bring with you:
- A valid form of government ID
- Your insurance card(s)
- A list of all of your medications
- If you are the legal guardian or guarantor, please bring the legal documents with you at the time of the appointment.
The patient record is an important legal and professional document. Rules governing their ownership, maintenance, content, access and confidentiality are subject to strict legal review and control by several governmental agencies. Our goal is to protect and maintain the integrity and confidentiality of our patients' health information. This information may not be released to anyone under any circumstances, except by court order or waiver signed by the patient (or parent or legal guardian as appropriate).
Request Your Records
Patients have the right to access the information contained within their records. Patient requests for copies of records or radiographs should be directed to the Director of Patient Services or designee. A written request is required since penalties for breach of information contained in the record may be severe.
Know Your Rights
Patients' Bill of Rights
The faculty, residents, students, and staff of the Dental Care Center recognize that while you are a patient here you have a right, consistent with the law to:
- Understand and use these rights. If for any reason you do not understand, or need help, the Dental Care Center will provide assistance, including an interpreter.
- Receive treatment without discrimination as to race, sex, sexual orientation, gender identity or expression, religion, age, color, creed, national or ethnic origin or sponsor, disability, marital status, familial status, pregnancy, genetic predisposition, criminal convictions, domestic violence victim status, and veterans or military status and all other protected classes under federal or state laws.
- Be treated with consideration, respect and dignity including privacy in treatment. Receive considerate, respectful, and confidential care in a clean and safe environment free of unnecessary restraints.
- Be informed of the services available at the center.
- Be informed of the provisions for off-hour emergency coverage. Receive emergency care if you need it, provided that the care which is required can be delivered consistent with the educational program of the school and the personnel and facilities of the clinic.
- Be informed of and receive an estimate of the charges for 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.
- Receive an itemized copy of his/her account statement, upon request.
- Obtain from his/her health care practitioner, or the health care practitioner’s delegate, complete and current information concerning his/her diagnosis, treatment and prognosis in terms the patient can be reasonably expected to understand.
- Receive from his/her physician/dentist information necessary to give informed consent prior to the start of any nonemergency procedure or treatment or both. An informed consent shall include, as a minimum, the provision of information concerning the specific procedure or treatment or both, the reasonably foreseeable risks involved, and alternatives for care or treatment, if any, as a reasonable medical practitioner under similar circumstances would disclose in a manner permitting the patient to make a knowledgeable decision.
- Refuse treatment to the extent permitted by law and to be fully informed of the medical consequences of his/her action.
- Refuse to participate in experimental research.
- Voice grievances and recommend changes in policies and services to the center’s staff, the operator and the New York State Department of Health without fear of reprisal.
- Express complaints about the care and services provided and to have the center investigate such complaints. The center is responsible for providing the patient or his/her designee with a written response within 30 days if requested by the patient indicating the findings of the investigation. The center is also responsible for notifying the patient or his/her designee that if the patient is not satisfied by the center response, the patient may complain to the New York State Department of Health: (518) 474-3817
- Privacy and confidentiality of all information and records pertaining to the patient’s treatment.
- Approve or refuse the release or disclosure of the contents of his/her medical record to any health-care practitioner and/or health-care facility except as required by law or third-party payment contract;
- Access to his/her medical record per Section 18 of the Public Health Law, and Subpart 50-3. For additional information link to: http://www.health.ny.gov/publications/1449/section_1.htm#access;. Review your dental record without charge, and/or obtain a copy of your dental records and/or obtain a copy of your x-rays, for which the Dental Care Center can charge a reasonable fee. You cannot be denied a copy solely because you cannot afford to pay.
- Authorize those family members and other adults who will be given priority to visit consistent with your ability to receive visitors.
- 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). The health care proxy is available from the center.
- View a list of the health plans and the hospitals that the center participates with.
- Receive an estimate of the amount that you will be billed after services are rendered.
- Know the names, positions, and functions of any member of the faculty, student body, and staff of the Dental Care Center, involved in your care and to refuse their treatment, examination or observation.
- Continuity and completion of treatment.
- Treatment that meets the standard of care in the dental profession.
Guide to Patient Services
The Guide to Patient Services is provided to each person upon arrival for their first visit and serves as a reference for a patient’s rights and as a guideline for the policies of the Dental Care Center.
Financial Policy and Information
Patients are expected to pay in full for treatment rendered at the time of service. We are participants in several insurance plans. For non-participating plans, upon request, we will provide you with an ADA claim form and all diagnostic tools, which you can submit to your insurance company for reimbursement.
- For the plans that the Dental Care Center (DCC) participates with, patients are responsible for all deductibles and copayments associated with their insurance.
- For Urgent Care Center appointments, only cash or credit cards are accepted as payment, unless eligible for coverage under insurance plans or other benefits.
- For insurance or finance inquiries, please call (631) 632-8989 and follow the prompts.
To view more detailed policy information online, please view page nine of our Guide to Patient Services.
Provided below is a list of the dental plans that we participate with. It is important for you to check whether we participate in your specific plan. Please contact your plan to confirm our participation.
Medicaid / Medicaid HMO Plans
|Dental Carrier||Dental Plan|
|New York State||Medicaid|
|Dentaquest||Affinity Health Plan|
|Dentaquest||Affinity Health – Child & Family Plus (CHP)|
|Dentaquest||Fidelis (Child Health Plus)|
|Dentaquest||Fidelis Adult Medicaid|
|Dentaquest||Healthfirst Family Health Plus|
|Dentaquest||Healthfirst (Child Health Plus)|
|Dentaquest||Emblem Health Plan (Child Health Plus)|
|United Health Care||Community Plan Medicaid|
|United Health Care||Community Plan Child Health Plus|
Private Dental Insurance Accepted
CSEA Employee Benefit Fund
Delta Dental PPO*
Emblem Health Preferred PPO**
* We do not participate with Delta Care USA. Delta has many dental plans; please check your card for the correct plan.
** This includes GHI and HIP (No HMO)