Dental VA Statement of Work Template

This operational template is not a legal agreement. Have qualified counsel review the complete contractual arrangement.

Role and outcome

Role title: ______

Owned outcome: ______

Practice manager: ______

Provider or worker: ______

Included work

Daily: ______

Weekly: ______

Monthly: ______

When triggered: ______

Explicit exclusions

The role does not include: ______

Clinical, licensed, physical-presence, financial-authority, or other prohibited work: ______

Volume and capacity

Planning volume: up to ______ per day / week / month.

Hours: ______ per week.

Required windows in practice local time: ______

Dedicated / shared / pooled: ______

Absence and holiday coverage: ______

When volume exceeds the assumption: approved extra hours / written priority order / other: ______

Deliverables and measures

Deliverables: ______

Leading measures and baselines: ______

Outcome measures and baselines: ______

Reporting cadence: ______

Practice responsibilities

• Provide timely access and required equipment
• Supply current procedures and policy decisions
• Name a manager and backup
• Protect onboarding and training time
• Review early work and answer escalations

Additional responsibilities: ______

Provider or worker responsibilities

• Follow the approved process and decision rights
• Protect confidential and patient information
• Report incidents and blocked work promptly
• Maintain agreed documentation and handover records

Additional responsibilities: ______

Review and change

Day 30 review: ______

Day 60 review: ______

Day 90 review: ______

How scope changes are requested, priced, approved, and recorded: ______