RIBCCDP CLINICAL SUPERVISION RECEIVED LOG
Counselor Name:_______________________________________
CORE FUNCTIONS: Date Hrs.Init Date Hrs.Init Date Hrs.Init Date Hrs.Init Date Hrs.Init Date Hrs.Init
SCREENING                        
INTAKE                        
ORIENTATION                        
ASSESSMENT                        
TREATMENT PLANNING                        
COUNSELING                        
CASE MANAGEMENT                        
CRISIS INTERVENTION                        
CLIENT EDUCATION                        
REFERRAL                        
REPORT & RECORD KEEPING                        
CONSULTATION                        
Please have your Clinical Supervisor date, initial, document hours and sign below
Clinical Supervisor Signature Clinical Supervisor Initials
Clinical Supervisor Signature Clinical Supervisor Initials