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Dental VA Recovery Plan Template

Dental Practice · Template · 5 sections

Last reviewed:

Quick answer

A time-bound plan for correcting one performance problem with clear evidence, actions for both sides, review rules, and a written decision date.

Use this template for performance problems. Follow the appropriate formal process for suspected misconduct, privacy incidents, security events, or legal matters.

Problem and evidence.

Affected workflow: ______

Observed result: ______

Examples, dates, and measures: ______

Expected standard: ______

Working cause.

Expectation / process / provider / skill / judgment / reliability / role fit

Why this is the likely cause: ______

Actions.

Practice will: ______

VA will: ______

Provider will, if applicable: ______

Procedure, training, access, or scope changes: ______

Review plan.

Temporary review rate: ______

Success measure and threshold: ______

Sample size or evidence period: ______

Checkpoint date: ______

Decision at checkpoint.

Continue and restore prior autonomy / extend the plan / re-scope / replace / switch provider / end engagement

Reason and evidence: ______

What changes before any new person begins: ______

Sections

  1. Problem and evidence
  2. Cause and affected workflow
  3. Practice and VA actions
  4. Measures and review rate
  5. Checkpoint decision

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