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Worker revised 08/07 form 1800 37A-522 which requires that licensed clinical social worker or a licensed mental health professional acceptable to the Board as specified in Section 4996. Statement for Supervisors of an Associate Clinical Social Worker revised 12-05 08/07 form 1800 37A-522 within 30 days of prior to commencement of any supervision. A copy of this form shall be provided to the associate by the supervisor.

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