Transcription of GENERAL SUPERVISION EVALUATION FORM FOR …
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GENERAL SUPERVISION EVALUATION FORM FOR …
OBLADC form 208 11/2012 1 GENERAL SUPERVISION EVALUATION form FOR DRUG AND ALCOHOL licensure /CERTIFICATION ELIGIBILITY LADC - Typically 50 completed hours of educational SUPERVISION / 2000 completed hours of practice/work hours under SUPERVISION CADC - Typically 100 completed hours of educational SUPERVISION / 4000 completed hours of practice/work hours under SUPERVISION LADC/MH - Typically 50 completed hours of educational SUPERVISION / 2000 completed hours of practice/work hours under SUPERVISION PARTIAL SUPERVISION (Due to a change in status, change of SUPERVISION , change of employment): Number of completed hours of SUPERVISION this EVALUATION :_____ Hours to present date: _____ SUPERVISEE Other name(s) under which evaluations have been submitted Home Address - Street/City/State/Zip
OBLADC Form 208 11/2012 1 GENERAL SUPERVISION EVALUATION FORM FOR DRUG AND ALCOHOL LICENSURE/CERTIFICATION ELIGIBILITY LADC - Typically 50 completed hours of educational supervision / 2000 completed hours of practice/work hours under supervision CADC - Typically 100 completed hours of educational supervision / …
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OKLAHOMA ADMINISTRATIVE CODE TITLE 435., Oklahoma administrative code . title 435. state board of medical licensure, Supervision . chapter 30. occupational therapists, Oklahoma State Board of Medical Licensure and, Oklahoma State Board of Medical Licensure and Supervision, Medical, Oklahoma, Your State allow persons licensed in, OVERVIEW, State, CARLO PAPPONE, MD, PhD, FACC