Clinical Supervision Form

At our last licensing inspection we were cited for incomplete documentation for individual clinical supervision. This is a requirement for continued licensure. This form will insure that going forward this will never happen again. The exact hourly requirements are posted on this page within the next week. In the meantime, please start using this form.

Instructions:

• Completion of this form by supervisors is mandatory.
• This form is to be completed and submitted within 24 hours of providing a clinical supervision session.
• All fields are required to be filled out.
• Both supervisors and individual providers are responsible for keeping their supervision hours up to date.

Supervision Requirements:

• occur at a minimum frequency of one (1) hour of clinical supervision for each twenty (20) hours of direct client contact by the clinician or not less than one (1) hour per calendar quarter in the case of a part time clinician.
• include review of case records, case management supervision, and participation in the development of the private provider’s training plan to upgrade their clinical skills.
• maintain a log of clinical supervision meetings that shall contain date, duration, and content of supervision meetings. document any discussion or changes pertaining to the client’s treatment plan.