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.
North Carolina Supervision Professional Disclosure Statement
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How to fill out North Carolina Supervision Professional Disclosure Statement?
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Examples Of Professional Disclosure Statements For Counseling Other Form Names
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