Dear Patient: Thank you for choosing to participate in the Dental Hygiene Program at CNCC. To make an appointment please call 970-675-3250 or 1-800-562-1105 ext 250. We offer the following services based on the student/faculty assessment of your dental hygiene needs:
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Health history assessment
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Extraoral and intraoral exam, including oral cancer screening
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Oral hygiene evaluation and preventive measures
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Oral prophylaxis (cleaning)
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Non-surgical periodontal therapy
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Additional indicated periodontal gum therapy, including local antimicrobials (medications)
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Tooth whitening
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Patient education
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Fluoride treatment
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Radiographs (x-rays)
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Pit and fissure sealants
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Nutrition counseling
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Impressions and study models
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Mouth guard fabrication
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Smoothing and polishing restorations (fillings)
THIS PROGRAM DOES NOT:
Take the place of a periodic examination and diagnosis by your dentist, or services provided by a dentist, such as fillings, crowns, root canals, extractions, partials, or dentures.
Note: Radiographs (x-rays) will be taken only when they can be sent to your dentist or they are required to assess your oral health.
Cost: The cost of dental hygiene services at CNCC for adults is determined by oral health classification. The cost ranges from $20.00 to $50.00. Senior citizen fees are 1/2 of the applicable adult fee. For children the cost is $10.00. Sealants are $7.50 per tooth. Some optional treatments may require an additional charge. Please consult with your student hygienist on the fees charged you.
PATIENTS’ BILL OF RIGHTS
As a patient in the Dental Hygiene Clinic at Colorado Northwestern Community College, Rangely, Colorado, you have the right, consistent with law to:
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Understand and use these rights. If for any reason you do not understand or you need help, the clinic will provide assistance.
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Receive treatment without discrimination as to race, color, religion, sex, national origin, disability, sexual orientation, or source of payment.
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Receive considerate and respectful care in a clean and safe environment, free of unnecessary restraints.
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Know the names, positions, and functions of any dental hygiene instructors, staff, and students in the dental hygiene clinic who are involved in your care.
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Refuse treatment, examination, or observation by any instructors or students.
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A no-smoking area. Please use the outdoor area if you wish to smoke.
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Receive complete information about any referral that is advised.
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Receive information that you need in order to give informed consent prior to any proposed procedure or treatment.
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Refuse treatment and be told what effect this may have on your health.
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Refuse to take part in research. In deciding whether or not to participate, you have the right to a full explanation.
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Privacy while in the clinic and, consistent with law confidentiality regarding all communication, information and records pertaining your care.
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Participate in all decisions about your treatment at this dental hygiene clinic.
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Review your dental hygiene record, and obtain a copy of your dental hygiene record, for which the clinic can charge a reasonable fee.
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Complain without fear of reprisal, regarding the care and services you are receiving. If you are not satisfied with the clinic’s response, you can complain to the Dean of Academic Services, Bob Horntvedt (970)675-3258 or the Colorado State Board of Dental Examiners, (303) 894-7758.
These "patient rights" go hand-in-hand with "patient responsibilities" to allow staff, faculty, and students meet to patient needs. We ask that you assume responsibility for:
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Providing, to the best of your knowledge, accurate and complete information about present complaints, past illnesses, hospitalization, medication, and other matters relating to your health.
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Reporting unexpected changes in your health to the clinician.
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Reporting whether you clearly comprehend the planned course of treatment and what is expected of you.
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Following the treatment plan recommended for your care.
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Keeping appointments punctually, and, when you are unable to do so for any reason, notify the clinic.
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Your actions if you refuse treatment or do not follow the clinician’s instructions.
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Assuring that the financial obligations for your healthcare are fulfilled promptly.
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Following clinic rules and regulations affecting patient care and conduct.
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Being considerate of the rights of other patients and clinic personnel.
Every person treated by the student hygienists at Colorado Northwestern Community College Dental Hygiene program is required to to read and sign this form before treatment.
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