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North Carolina Supervision Professional Disclosure Statement

State:
North Carolina
Control #:
NC-70234NMS
Format:
Word; 
Rich Text
Instant download

Description Nc Will Template

This form is very similar to a professional CV specifically for North Carolina mental health professionals.
The North Carolina Supervision Professional Disclosure Statement is a document which outlines the roles, responsibilities, and qualifications of a professional providing supervision services in North Carolina. It is a legally binding document which must be signed by both the supervisor and supervised prior to the start of the supervision relationship. The Statement includes information such as the supervisor’s qualifications, the scope of the supervision services to be provided, the fees and payment policy, the liability disclaimer, and any other relevant information. The Statement also includes a section where the supervised may disclose any potential conflicts of interest or ethical issues. The North Carolina Supervision Professional Disclosure Statement comes in two forms: the Standard Form and the Customized Form. The Standard Form contains the basic information regarding the supervision services that is required by the North Carolina Licensing Board. The Customized Form is tailored to the individual needs of the supervisor and supervised and typically includes more specific information about the scope of the supervision services and the fees and payment policy.

The North Carolina Supervision Professional Disclosure Statement is a document which outlines the roles, responsibilities, and qualifications of a professional providing supervision services in North Carolina. It is a legally binding document which must be signed by both the supervisor and supervised prior to the start of the supervision relationship. The Statement includes information such as the supervisor’s qualifications, the scope of the supervision services to be provided, the fees and payment policy, the liability disclaimer, and any other relevant information. The Statement also includes a section where the supervised may disclose any potential conflicts of interest or ethical issues. The North Carolina Supervision Professional Disclosure Statement comes in two forms: the Standard Form and the Customized Form. The Standard Form contains the basic information regarding the supervision services that is required by the North Carolina Licensing Board. The Customized Form is tailored to the individual needs of the supervisor and supervised and typically includes more specific information about the scope of the supervision services and the fees and payment policy.

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Clinical Supervision Log Template Form popularity

Examples Of Professional Disclosure Statements For Counseling Other Form Names

Ncbl E Library   Statement Of Disclosure Counseling   Professional Disclosure Statement Template  

FAQ

You must retain all documentation for 7 years following certification. Currently, the BACB requires the following documentation for each supervision experience: Monthly Fieldwork Verification Form (Monthly-FVF) Unique documentation system.

I will keep confidential anything that you say to me, with the following exceptions: a) you direct me to tell someone else, b) I determine that you are a danger to yourself or others, c) I am ordered by a court to disclose information, d) I suspect or am made aware of physical/sexual abuse of minors, persons with

What is the The Professional Disclosure Statement? The name, title, business address, and business telephone number of the professional clinical counselor, professional counselor,

Professional Disclosure Statements For Mental Health Professionals Contact info. Your qualifications including training, experience, licensure and certifications. Professional associations that you belong to. Any limitations on your practice such as being under supervision. Services offered.

The professional disclosure statement (PDS) is a document that an LPC, LMFT, or registered associate gives to each client that provides information about the licensee/registered associate and their practice. Who must have a PDS? Every applicant for licensure must submit a PDS as part of his or her application.

I will keep confidential anything that you say to me, with the following exceptions: a) you direct me to tell someone else, b) I determine that you are a danger to yourself or others, c) I am ordered by a court to disclose information, d) I suspect or am made aware of physical/sexual abuse of minors, persons with

More info

4) Complete supervision record at each supervision session. 5) Maintain licensure as a Mental Health Counselor (LMHC) in Washington and status as an approved.Complete supervision record at each supervision session. Maintain licensure as a clinical supervisor in NC and status as a NBCC approved clinical supervisor. This document is designed to inform you about this supervisor and to explain the supervisory relationship and expectations. I completed my Practicum in Counseling at the Happy Tails Counseling in the Spring 2015 semester, and am completing my Internship there presently. It will inform you of the purposes, goals, evaluative measures, confidentiality issues and requirements of supervision. I will ask all involved to maintain confidentiality but cannot guarantee complete privacy of group sessions outside of supervision. The priority in the supervision process is accountability for client care within the parameters and ethical standards of the counseling profession. LPCA Professional Disclosure Statement.

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North Carolina Supervision Professional Disclosure Statement