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STATE OF ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS 1740 WEST ADAMS STREET, SUITE 3600 PHOENIX, AZ 85007 PHONE: 602.542.1882 FAX: 602.364.0890 Board Website: www.azbbhe.us Email Address: information@azbbhe.us KATIE

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How to fill out verification of clinical supervision

01

Obtain the verification of clinical supervision form from the appropriate governing body or organization.

02

Fill in your personal details such as your name, contact information, and any identification numbers required.

03

Provide details of the clinical supervisor including their name, contact information, and qualifications.

04

Include the dates and times of supervision sessions, as well as the total number of hours completed.

05

Have both you and your clinical supervisor sign and date the form to verify its accuracy.

Who needs verification of clinical supervision?

01

Individuals who are working towards a professional license or certification in a healthcare or mental health field

02

Students completing clinical placements or internships as part of their academic program

03

Healthcare professionals seeking to demonstrate completion of required supervisory hours for continuing education or professional development

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What is verification of clinical supervision?

Verification of clinical supervision is a process where a licensed clinical supervisor documents and confirms that they have provided supervision to a supervised individual in a clinical setting.

Who is required to file verification of clinical supervision?

Supervised individuals who are completing their clinical hours as part of their licensure requirements are required to file verification of clinical supervision.

How to fill out verification of clinical supervision?

Verification of clinical supervision can be filled out by the clinical supervisor, who must provide their information, the supervised individual's information, the dates and hours of supervision, and sign off on the document.

What is the purpose of verification of clinical supervision?

The purpose of verification of clinical supervision is to ensure that supervised individuals have met the required clinical supervision hours as part of their licensure process.

What information must be reported on verification of clinical supervision?

Information that must be reported on verification of clinical supervision includes the names of the supervisor and supervised individual, dates and hours of supervision, and any additional notes or comments.

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