Professional Disclosure Statement Template

• Category: North Carolina Confidentiality and Nondisclosure - Employment
• State: North Carolina
• Control #: NC-70234NMS
• Format: Word; Rich Text

Description

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.