Clinical Supervision Log

Supervisor:    [text name="Supervisor:" default="staff    name"]
Supervisee:    [text name="Supervisee" default="staff    name"]
Date    [date name="variable_1" default="05/09/2024"]
Supervision    Type:    [checkbox name="Supervision    Type" value="Individual    (1    hour)|Group    (1    hour)|Group    (2    hours)"]
General    Clinical    Therapeutic    Issues:[checkbox name="variable_1" value="abuse|anxiety|depression|family    of    origin|gender    identity|grief|health    status|personality    disorder|relationship    conflict|sexual    orientation|transference/counter-countertransference|trauma|other"][text name="variable_1" default=""]
Non-Therapeutic    Issues:[checkbox name="variable_1" value="documentation|treatment    planning|licensure|agency    policy/procedure|other"][text name="variable_1" default=""]
Clientcode:[text name="variable_1" default="client    code    only"]
Main    Clinical    Issue:[text name="variable_1" default=""]
Clinical    Strategy:[textarea name="variable_1" default=""]
Other    supervisor    guidance/recommendations:[textarea name="variable_1" default=""]
Supervisor    Signature:
Supervisee    Signature:
Supervision Type:
General Clinical Therapeutic Issues:
Non-Therapeutic Issues:
Main Clinical Issue:
Clinical Strategy:

Other supervisor guidance/recommendations:

Supervisor Signature:
Supervisee Signature:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.33, 12 form elements, 25 boilerplate words, 6 text boxes, 2 text areas, 1 dates, 3 checkboxes, 30 total clicks
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