Privileging - Clinical Social Worker
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Check the boxes next to the privileges you seek.
Mental health assessment
Sever mental illness referral
Substance abuse referral
Crisis counseling
Nonclinical psycosocial needs assessment and referral
Treatment modality assessment and recommendation
Individual counseling - pediatric
Individual counseling - adolescent
Individual counseling - adult
Couples counseling
Family counseling
Group counseling
Case management
Tobacco cessation
Medical translation (enter language)
Any other privileges not listed here?
Comments/concerns:
I attest that I have appropriate training, competence, experience, and comfort level for each privilege requested.
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