Statement of work template for medical record review
Answer in brief: a record review statement of work needs 12 clauses: parties, purpose, records, deliverables, citation rule, format, reviewer qualifications, AI use, turnaround, price, PHI handling, and revisions with acceptance. Copy the template below, fill the brackets once, and send the same text to every service you ask for a quote.
Limits: We have not ordered work from the services listed: prices and turnaround times are what each service publishes on its own site on the date shown, and the worked example uses a synthetic file.
Why write the scope before you ask for quotes
3 quotes on 3 different scopes can't be compared. One service quotes a chronology, another a chronology plus a narrative, a third an hourly estimate with no page count. A single statement of work forces every vendor to price the same job, and it becomes the document you hold them to when a date is wrong or a delivery is late.
None of the top Google results for this search gives a contract-ready scope. Buyer's guides from vendors list questions to ask. This template turns the answers into terms.
The template
Plain text. Replace every [bracket]. Delete clauses that don't apply, such as the IME items for a hospital peer review.
STATEMENT OF WORK: MEDICAL RECORD REVIEW
Version [1.0], dated [YYYY-MM-DD]
1. PARTIES
Client: [practice, hospital department or physician name] ("Client").
Vendor: [service name, legal entity, address] ("Vendor").
This statement of work is governed by the master services agreement dated [date], if any, and by the business associate agreement in clause 11.
2. PURPOSE
Vendor will organize and summarize medical records so that Client's physician can review them. Purpose of the review: [IME / QME / expert review / external peer review / claim review / other: ___].
Vendor will not provide, draft or suggest any medical opinion, including causation, standard of care, apportionment, maximum medical improvement or impairment, unless clause 4(h) is selected.
3. RECORDS
Client will upload records through [Vendor portal / SFTP / other] as [PDF / other].
Expected volume: about [N] pages per file, [N] files per month.
Vendor will confirm the page count in writing within [1] business day of upload, stating:
(a) total pages received;
(b) exact duplicate pages found;
(c) pages illegible or unreadable, with page numbers.
4. DELIVERABLES (select)
[ ] (a) Medical chronology: 1 entry per encounter, with date, provider, facility, encounter type, findings, diagnoses, procedures, medications, and source page.
[ ] (b) Records reviewed list: provider, date range, page range for each source.
[ ] (c) Missing records list: records referenced in the file but not received.
[ ] (d) Flags: gaps in care over [N] days; prior complaints to [body part]; imaging impressions quoted verbatim; work status changes.
[ ] (e) Narrative summary of no more than [N] pages.
[ ] (f) Billing summary by provider and date.
[ ] (g) Bookmarked and hyperlinked PDF of the source records.
[ ] (h) Signed medical opinion by a [specialty] physician, board certified in [board], on these questions: [list]. Priced separately under clause 10.
5. CITATION RULE
Every chronology entry and every statement in a narrative cites the source page number in the record set as uploaded [or as Bates numbered by Vendor].
An entry without a citation, or with a citation that does not support it, is a defect under clause 12.
Where the record is illegible or ambiguous, Vendor marks the entry "unclear" and cites the page rather than guessing.
6. FORMAT
Deliverables in [Word and PDF / Excel / Client's template, attached].
Dates in [YYYY-MM-DD / MM/DD/YYYY]. Entries in [date order / provider order].
Medical terms as written in the record; no paraphrase of imaging impressions or diagnoses.
7. REVIEWER QUALIFICATIONS
Chronology prepared by [RN / physician / trained medical summarizer] and checked by [RN / physician] before delivery.
Vendor will name the credential of the preparer and the checker on each deliverable.
For clause 4(h), Vendor discloses the reviewer's name, specialty and any relationship with the parties before the review starts.
8. USE OF AI AND SUBCONTRACTORS
Vendor will list every software tool that processes Client records, including AI tools, and every subcontractor or location where records are processed: [list].
Vendor will not add a tool, subcontractor or processing country without Client's written consent.
No Client record will be used to train any model.
9. TURNAROUND
The clock starts at [complete upload / Client's written approval of the page count and price].
Standard delivery: [N] business days for files up to [N] pages. Larger files: delivery date stated in the quote.
Rush: [N] hours at [N]% over the standard price, confirmed in writing before work starts.
Late delivery without 1 business day of notice reduces the price of that file by [N]%.
10. PRICE
Basis: [per page / per hour / per file].
Rate: [$___]. Minimum per file: [$___].
Pages billed: [all pages received / pages after exact duplicates are removed].
Hourly work: Vendor sends an hours estimate before starting and does not exceed it by more than [10]% without written approval.
Add-ons from clause 4 are priced at: [list].
Supplemental records after delivery: added at [rate] within [N] business days.
Invoices are issued [after delivery / monthly] and due in [30] days.
11. PRIVACY AND SECURITY
Vendor signs Client's business associate agreement before receiving any record.
Records are encrypted in transit and at rest.
Access is limited to named staff working on the file.
Vendor deletes or returns all records and copies within [30] days of final delivery and confirms deletion in writing.
Vendor reports any security incident involving Client records within [N] days of discovery.
12. REVISIONS AND ACCEPTANCE
Client has [10] business days after delivery to report defects: wrong date, wrong or missing citation, wrong patient, omitted encounter, or failure to follow clause 6.
Vendor corrects reported defects within [3] business days at no charge.
Client may check a random sample of [20] entries against the cited pages. If [2] or more are defective, Vendor re-checks the full deliverable at no charge.
The deliverable is accepted when defects are corrected or the review period ends without a report.
SIGNED
Client: ____________________ Date: __________
Vendor: ____________________ Date: __________Clause notes: why each term is there
| Clause | The problem it prevents |
|---|---|
| 2, purpose and no opinion | A vendor's causation sentence ending up in a report a physician signs |
| 3, page count in writing | Paying for pages that were duplicates or unreadable; none of the 11 price pages we read says how duplicates are billed |
| 4(d), flags | A chronology that lists every visit but misses the 1 prior back complaint that decides the case |
| 5, citation rule | Summaries you can't check without re-reading the file |
| 7, credentials on each deliverable | Not knowing whether a nurse, a physician or neither prepared the work |
| 8, AI and subcontractors | Records processed by tools or in countries your BAA doesn't cover |
| 9, clock start | "48 hours" that starts 2 days after upload |
| 10, hours cap | An hourly estimate that doubles; published examples for 500 pages range from 5 to 10 hours |
| 12, sample check | Arguing about quality without a test; 20 entries is enough to see a pattern |
How to run the 20-entry check
- Number the chronology entries and pick 20 at random (a spreadsheet RAND() column works).
- For each, open the cited page and confirm the date, provider and finding.
- Mark each entry correct, wrong date, wrong page, wrong fact, or unsupported.
- Then pick 3 encounters you know are in the record and check that each has an entry.
- Record the counts. 2 or more defects in 20 triggers the re-check in clause 12.
On a page-cited chronology this takes a physician about as long as reading 20 short notes. Without citations you are re-reading the record to find each fact, which defeats the purpose of buying the service.
Questions about the statement of work
Do I need a statement of work for a single file?
Yes, a short one. The page count, citation rule, clock start and price basis take a paragraph and prevent most disputes. Send the same text to every vendor you ask for a quote.
Should the SOW ban AI?
Not necessarily. Clause 8 asks the vendor to name every tool and location that touches the records, so you can confirm the BAA covers them. Banning AI outright may raise the price without making the summary more accurate.
Who should sign the SOW on the client side?
The person who can bind the practice or hospital department to the price, usually a practice owner, administrator or the medical staff office lead. The business associate agreement may need a separate signature from your privacy officer.