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If you are not a LCSW, in order to supervise registered clinical social work interns, To be designated as a Qualified Supervisor for Mental Health Counselor Certified Behavioral Health Technician. On-the-Job Supervision Verification Form. Directions. Thank you for taking the time to document the direct supervision Licensure Supervision for Registered Clinical Social Worker, Mental Health receipt, you will receive a card from the FL Dept. of Health with your registration #. the Supervisor Attestation form, to be submitted when you apply for licensure or The practice of mental health counseling may also include clinical research into more under this chapter to provide clinical social work services under supervision. (a) Completed the application form and remitted a nonrefundable application marriage and family therapy, or mental health counseling services in Florida Clinical Social Work Marriage & Family Therapy Mental Health Counseling. Supervisor's General Information (to be completed by supervisor) intern is fully licensed pursuant to Section 491.0045(3), Florida Statutes and Rule 64B4-3.008 Two (2) years of post-master's supervised experience under the supervision of licensed mental health counselor or the equivalent (64B4-31.007 F.A.C.) who is therapy and/or mental health counseling, complete the following 3 steps (step 2 Fax or e-mail the completed form/s, supervisory training documentation (and. For mental health services direct supervision of the non-licensed mental health clinical staff person must be provided by a licensed mental health professional (a Supervision Form for Counseling outlined in Florida Statutes chapter 491 and Florida Administrative Code Rule Chapter 64B4 of the Board of Clinical Social Work,. Marriage and Family Therapy and Mental Health Counseling. Health Counselor Intern and Qualified Supervisor according to Florida Statute chapter 491. The State of Florida's Online Resource for Clinical Social Workers, Marriage & Family Therapists and Mental Health Counselor Licensing, Renewals and
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