Now you can pay your dental bill ONLINE.
Important Information About Cashless Payments
To enhance our Baltimore patients’ experience at the School of Dentistry and to offer convenience and flexibility, we will be moving to cashless payments, effective August 1, 2024.
We will continue to accept payments with credit cards and check. For those that will still want to pay for services with cash, you will be able to use our REVERSE ATM machine to convert your cash onto a debit payment card for easy processing and acceptance in all of our clinics. There will not be any charges to you for this service. The School of Dentistry will manage any conversion cost associated with the use of the ATM. These cards can also be used anywhere MASTERCARD is accepted.
A Reverse ATM will be available on the first floor at the top of the access ramp and next to the security desk. Please stop here to make your Cash-To-Card conversion prior to going to your clinic appointment.
Thank you for your cooperation as we make advancements in our technology to better serve you.
Patient Communication, Forms, and Policies
HIPAA Substitute Notice
CHC has provided a HIPAA substitute notice with additional information here:
https://www.changehealthcare.com/hipaa-substitute-notice.
The notice includes a description of information which may have been involved based on CHC’s review to date, a toll-free call center number, and information on complimentary credit monitoring and identity protection services available to all individuals. CHC recommends that covered entities post a link to the substitute notice on their home page for at least 90 consecutive days.
HIPAA and Compliance Policies
- Notice of Privacy Practices PDF PDF
- Nondiscrimination Notice PDF PDF
- Nondiscrimination Policy for persons with disabilities and limited English proficiency PDF PDF
- Nondiscrimination Statement - Language Accessibility PDF PDF
- CHC HIPAA Substitute Notice
Patient Forms
- Records Release Forms
- Private Practice Records Release Request PDF PDF
For use by UMSOD patients and private practice offices to request the release of patient records. - Authorization for the Use and Disclosure of Protected Information PDF PDF
- Private Practice Records Release Request PDF PDF
- Health Record Correction Requests
- Backline Patient Instructions
Patient Bill of Rights
Each patient is entitled to:
- Considerate, respectful and confidential treatment;
- Continuity and completion of treatment;
- Access to complete and current information about his/her condition;
- Advance knowledge of the cost of treatment;
- Informed consent;
- Explanation of recommended treatment, treatment alternatives, the option to refuse treatment and risk of no treatment and expected outcomes of various treatments;
- Emergency, incremental and total patient care;
- Treatment that meets the standard of care in the profession;
- Access to a patient advocate who will appropriately communicate your experience.
To communicate your experience, please contact your clinic's patient care coordinator at the appropriate number below:
- 1ST Floor Urgent Care, Oral Surgery: 410-706-8127
- 2nd Floor Undergraduate Clinic: 410-706-8127
- 3rd Floor AEGD Clinic: 410-706-1250 OR 410-706-4156
- 3rd Floor Undergraduate Clinic: 410-706-8127
- 3rd Floor Orthodontics/Pediatric Dentistry Clinic: 410-706-0768
- 4th Floor Endodontics, Prosthodontics & Periodontics Clinic: 410-706-8111
- 4th Floor PLUS & Special Care and Geriatrics Clinics: 410-706-8127
- Universities at Shady Grove - UMB Health and Human Services: 240-665-6700
