audit report LCSW-BACS

Carmen

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• Publié par: Fyac
• Nombre de lectures: 45
• Langue: Breton

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L OUISIANA S TATE B OARDOF S OCIAL W ORK E XAMINERS LCSW-BACSCONTINUING EDUCATION AUDIT REPORT July 1, 2009 - June 30, 2010 Name:____________________________________________________________________________________ Address:__________________________________________________________________________________  ____________________________________________________________________________________ Credential No.:__________ Telephone: (_______)_____________________ Fax:_______________________ You must list 20 clock hours of continuing education which includes 10 hours in clinical content covering diag- nosis and treatment, 3 hours in social work ethics and 3 hours in clinical supervision.Ethics and clinical super- vision were to be completed between July 1, 2008 and June 30, 2010.Attach documentation verifying your attendance at the events. Please do not use initials when writing the names of the events or sponsoring organizations.  Auditor Use Only Hours  Month/Day/YearHours Approved Not Approved Event: ________ _________ __________________________________________________ _______________ _________  __________________________________________________ Presenter:________________________________________________________________________  SponsoringOrganization: ____________________________________________________________  ClinicalContent 9  Ethics 9  ClinicalSupervision 9 _________ _________ Event:_________________________________________________________ _______________  _________________________________________________ Presenter:________________________________________________________________________  SponsoringOrganization: ___________________________________________________________  ClinicalContent 9  Ethics 9  ClinicalSupervision 9 _________ _________ Event:_________________________________________________________ ________________  _________________________________________________ Presenter:________________________________________________________________________  SponsoringOrganization: ___________________________________________________________  Clinical Content 9  Ethics 9  ClinicalSupervision 9 →

Month/Day/Year Hours Event:___________________________________________________ _________________  ____________________________________________ Presenter: ______________________________________________________________________ Sponsoring Organization: ___________________________________________________________ ClinicalContent 9  Ethics 9 Supervision Clinical 9 Event:______________________________________________ _________________ _______  ______________________________________________ Presenter: _______________________________________________________________________ Sponsoring Organization: __________________________________________________________ ClinicalContent 9  Ethics 9  ClinicalSupervision 9 Event:______________________________________________ _________________ _______  ______________________________________________ Presenter: _______________________________________________________________________ Sponsoring Organization: ____________________ ______________________________________ ClinicalContent 9  Ethics 9 Supervision Clinical 9 Event:_______________________________________________ _________________ ______  _______________________________________________ Presenter: _______________________________________________________________________ Sponsoring Organization: ___________________________________________________________ ClinicalContent 9  Ethics 9  ClinicalSupervision 9 Event:______________________________________________________ _______________  _______________________________________________ Presenter: _______________________________________________________________________ Sponsoring Organization: __________________________________________________________ ClinicalContent 9  Ethics 9  ClinicalSupervision 9 Event:______________________________________________________ _______________  _______________________________________________ Presenter: _____________________________________________________________________ Sponsoring Organization: __________________________________________________________  ClinicalContent 9  Ethics 9  ClinicalSupervision 9

 Auditor Use Only Hours Approved NotApproved _________ _________ _________ _________ _________ _________ _________ _________ _________ _________ _________ __________

LICENSEE NAME_____________________________________ ADDRESS _____________________________________  _____________________________________  _____________________________________

*************************************************************************** AUDITOR USE ONLY: _____An Audit of this licensee’s continuing education report has been completed and the documentation has been found to be in compliance with all sections of Rule No. 317.  _____An audit of this licensee’s continuing education report has been completed and has revealed that the documentation is not in compliance with Rule No. 317 for the following reason(s): _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Recommendation: _________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Reviewed by:_____________________________________________Date:_____________________________ ****************************************************************************************************** Questions concerning your AUDIT should be directed to:  ASWB AUDIT LOUISIANA-CE Box 1508 PO VA 22701 Culpepper,  Phone:[phone]  Fax:[phone]  ContinuingEducation Requirements can be viewed on our websitewww.labswe.org.  SeeRule No. 317 of theRules, Standards and Procedures.