Supervision_Notice to Client - Board of Social Work



Kentucky Board of Examiners of Social Work

125 Holmes Street, Suite 310

Frankfort KY 40601

502-564-2350



Notice to Client

335.101 Purposes—Exemptions.

(1) It is the purpose and policy of the Commonwealth of Kentucky to protect the public from being misled by incompetent and unauthorized persons, and from unprofessional conduct on the part of qualified social workers by providing regulatory authority over persons who hold themselves out to the public as social workers.

(2) The purpose of KRS 335.010 to 335.160 and KRS 335.990 is to promote high standards of professional performance for those engaged in the profession of social work by regulating the title, and by setting standards of qualification, training, and experience for those who seek to engage in the practice of social work.

201 KAR 23:070 Section 5 Notice to Client. If an employee is practicing under the supervision of a licensed clinical social worker, the employee shall notify in writing each client during the period of the supervision. The notification shall contain:

(1) The Name, office address, telephone number, and license number of the supervisor of record and

(2) A statement that the employee is licensed by the board.

Supervisor of Record:

Name:      _______________________________

Office Address:      ________________________

     ________________________

Telephone Number:      _____________________

License Number:      ________________________

The signature below affirms that the certified social work (CSW) is practicing under the supervision of the above named supervisor of record and holds a license in good standing with the Kentucky Board of Social Work.

     _______________________________      _________________________

Certified Social Worker CSW License Number

(Employee)

Signature of Supervisor of Record: _________________________

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