Fillable Printable Social Work Licensure Information
Fillable Printable Social Work Licensure Information
Social Work Licensure Information
KENTUCKY BOARD OF SOCIAL WORK
44 Fountain Place, Frankfort, Kentucky 40601
(502)564-2350 ~ http://finance.ky.gov/bsw
Filing a Complaint
What are your rights?
You have a right to expect a professional standard of care and conduct from a social worker. If you believe a social
worker has violated Kentucky statutes or regulations, you may send a written complaint to the Kentucky Board of Social
Work. As the body responsible for regulating the social work profession and protecting the public in matters related to
social work, the Board will review your complaint and take appropriate action.
How does the complaint process work?
Complaints that have been received in writing at the Board office will be acknowledged immediately by letter. The
complaint will then be reviewed by the Board members at their next meeting. If no law appears to have been broken, you
will receive notification from the Board. If the Board believes a law may have been broken, an investigation will take
place. If the Board files formal charges against a psychologist as a result of the investigation, an administrative hearing
may be held. This formal hearing involves lawyers, a court reporter, a hearing officer and witnesses. If the Board finds
that the psychologist has not met the prescribed standard of care and conduct, it has the authority to impose penalties
ranging from suspension or loss of a certificate or license to a reprimand. A penalty may be reached by agreement
between the Board and the social worker.
What might I expect from filing a complaint?
The complaint process is a detailed and careful one, and you should expect some delay. In every case the social worker
will be informed that a complaint has been filed, the name of the complainant, and the disposition of the complaint. Not
every complaint results in disciplinary action by the Board if the social worker has not violated the laws governing social
work. If charges are filed, a hearing may be held similar to a court trial, and it is open to the public. You may be
subpoenaed as a witness to provide testimony regarding the case. In this event the Assistant Attorney General assigned
to the Board will assist you in preparing for the hearing. If the Board orders a specific sanction, the social worker has the
right to appeal, and a final decision may be delayed in the courts. While you may have an opinion regarding the process
and outcome of processing your complaint, please remember that the decisions to dismiss or settle a case or propose
disciplinary measures are solely the decision of the Board and may be subject to review by the courts.
If the Board files formal charges or takes formal action against a social worker, most portions of the investigative file will
become a “public record” which can be viewed by any individual who requests to do so. The record may include your
written complaint, transcripts, or reports of interviews, letters, and other reports. All testimony and evidence admitted in
a formal hearing have the status of public record as well. Patient
records obtained in the process of investigation usually can be
protected
from disclosure as public records.
Throughout the various stages of the complaint process, you will be kept informed. You will also be advised of the final
outcome.
How do I make a compliant?
You should complete the complaint form that accompanies this information sheet. Make sure you give all pertinent
information. Please sign the complaint from so that the Board may look further into your concerns. If your complaint
refers to treatment of a specific patient, the patient must sign the “Client Agreement to Release Information” form as well.
Complaints and release forms should be mailed to: Kentucky Board of Examiners of Social Work, 44 Fountain Place,
Frankfort KY 40601.
COMPLAINT FORM
APPLICATION INSTRUCTIONS
1. Please write or print legibly.
2. Once you have completed the form, you must print the form, and apply your handwritten signature. Complaint
forms submitted without the appropriate signatures will be returned.
3. The completed application may be submitted to the Kentucky Board of Social Work by mail to 44 Fountain Place,
Frankfort, Kentucky 40601.
Complaint No: Date Received:
KENTUCKY BOARD OF SOCIAL WORK
Complaint Form
Person Filing Complaint
Name:
Address: City: State: Zip Code:
Day Telephone: ( ) - Evening Phone: ( ) -
Patient Information
(If Applicable)
Name:
Address: City: State: Zip Code:
Day Telephone: ( ) - Evening Phone: ( ) -
Relationship to person filing
complaint:
Name of Social Worker
Name:
License Number:
Address: City: State: Zip Code:
Day Telephone: ( ) -
Name and phone number of persons who may provide additional information
1. Name: Telephone: ( ) - Type of Information:
2. Name: Telephone: ( ) - Type of Information:
3. Name: Telephone: ( ) - Type of Information:
4. Name: Telephone: ( ) - Type of Information:
Brief Summary of Complaint
(Please be specific as possible regarding names, dates, locations, and action which you believe to be improper, unethical or
unprofessional. Please attach copies of any documents or records pertinent to your complaint.)
By signing this complaint form, I hereby certify that the information is complete and true to the best of my knowledge.
Signature: ____________________________________ Date: ______________________________
If your complaint concerns your treatment by the social worker, please sign and enclose the “Client Agreement to Release
Information” form.
*********************************************************************************************************************
Send to: KENTUCKY BOARD OF SOCIAL WORK Phone: (502) 564-2350
44 FOUNTAIN PLACE Fax: (502) 696-8030
FRANKFORT, KY 40601
Authorization for Release of Medical and Psychological
Records to the Kentucky Board of Social Work
I, , the undersigned, do hereby authorize the full
(Print Name Here)
release of any and all medical and psychological records, billing information, and medical and psychological reports from
, Licensed/Certified/Clinical Social Worker,
regarding
the medical and psychological history, diagnosis, and treatment of me while a patient of the social worker to the
Kentucky Board of Social Work or any authorized agent or investigator of the Board.
I understand that the above records may be used by the Board I the investigation and possible disciplinary
prosecution under KRS Chapter 319 against the social worker. I further understand that the Board will make reasonable
efforts to protect the confidentiality of my records under KRS Chapter 61 and KRS Chapter 13B, or other applicable law.
A photocopy of this authorization shall be deemed as an original.
This authorization shall be effective for one year from the state of signing.
Date Signature of patient, or parent/legal guardian of patient
if under 18 years of age.
