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Board of Professional Counselors and Therapists 4201 Patterson Avenue Baltimore, MD 21215 4107644732 www.dhmh.maryland.gov/bopc/ REQUIRED CLINICAL SUPERVISED EXPERIENCE CPC Years of Total Clinical

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How to fill out supervisedclinicaldocumentationformdoc - dhmh md

01

The supervisedclinicaldocumentationformdoc - dhmh md is a form that needs to be filled out by healthcare professionals who are providing clinical services under supervision. This form is specific to the Maryland Department of Health and Mental Hygiene (DHMH) and is used for documenting important information related to supervised clinical practice.

02

To fill out the supervisedclinicaldocumentationformdoc - dhmh md, follow these steps:

2.1

Step 1: Begin by entering your basic information in the designated fields. This may include your name, credentials, contact information, and any relevant identification numbers.

2.2

Step 2: Next, provide details about the supervisor overseeing your clinical practice. Include their name, contact information, and any additional information required by the form.

2.3

Step 3: Proceed to fill out the section that includes information about the clinical practice setting. This may involve providing the name and address of the facility where supervised practice is taking place, as well as any other necessary details.

2.4

Step 4: The supervisedclinicaldocumentationformdoc - dhmh md also requires information about the duration and frequency of your supervised practice. Specify the start and end dates, the number of hours per week, and any additional details that demonstrate the extent of supervision provided.

2.5

Step 5: If applicable, provide information about the patients or clients you are serving during your clinical practice. This may include their age range, diagnoses, treatments, and any other relevant information.

2.6

Step 6: Finally, review the completed form for accuracy and make any necessary corrections before signing and dating it. Make sure to keep a copy for your records and submit the form to the appropriate entity as required.

03

Healthcare professionals who are providing clinical services under supervision, particularly in the state of Maryland, are the ones who need to fill out the supervisedclinicaldocumentationformdoc - dhmh md. This form helps ensure proper documentation and adherence to guidelines set by the Maryland Department of Health and Mental Hygiene. It is important for healthcare professionals to accurately and thoroughly fill out this form to demonstrate their compliance with supervisory requirements and ensure the quality and safety of patient care.

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