HMIS Forms and Documents

Client Assessment

Intake Forms

HMIS Intake/Enrollment Form – General: For all funding types except CoC/ESG, PATH, RHY, SSVF and VASH (revised 12/12/17)

HMIS Intake/Enrollment Form – General  For all funding types except SSVF, PATH, VASH, and RHY (Spanish) (revised 4/10/17)

HMIS Intake/Enrollment Form – CoC/ESG (revised 12/12/17)

HMIS Intake/Enrollment Form – PATH (revised 12/12/17)

HMIS Intake/Enrollment Form – PATH (Spanish) (revised 4/10/17)

HMIS Intake/Enrollment Form – RHY (revised 12/12/17)

HMIS Intake/Enrollment Form – RHY (Spanish) (revised 4/10/17)

HMIS Intake/Enrollment Form – SSVF (revised 12/12/17)

HMIS Intake/Enrollment Form – SSVF (Spanish) (revised 4/10/17)

HMIS Intake/Enrollment Form – VASH (revised 12/12/17)

HMIS Intake/Enrollment Form – VASH (Spanish) (revised 4/10/17)

Exit Forms

HMIS Client Exit Form – General: For all funding types except CoC/ESG, PATH, VASH, and RHY (revised 12/12/17)

HMIS Client Exit Form – General (Spanish): For all funding types except CoC/ESG, PATH, VASH, and RHY (revised 12/14/16)

HMIS Client Exit Form – CoC/ESG (revised 12/12/17)

HMIS Client Exit Form – CoC/ESG (Spanish) (revised 12/14/16)

HMIS Client Exit Form – PATH (revised 12/12/17)

HMIS Client Exit Form – PATH (Spanish) (revised 12/14/16)

HMIS Client Exit Form – RHY (revised 12/12/17)

HMIS Client Exit Form – RHY (Spanish) (revised 12/14/16)

HMIS Client Exit  Form – SSVF (revised 12/12/17)

HMIS Client Exit Form – VASH (revised 12/12/17)

HMIS Client Exit Form – VASH (Spanish) (revised 12/14/16)

CFCOC Forms

Supplemental CFCOC Client Intake Form for 2014-2015 (revised 1/22/15)

Supplemental CFCOC Client Exit Form for 2014-2015 (revised 7/1/14)

Miscellaneous

HMIS Update/Annual Assessment Form (revised 10/3/16)

HMIS Update/Annual Assessment Form (Spanish) (revised 8/9/16)

HMIS Follow Up Form (revised 01/05/16)

Agency Setup Forms

New Project Set-Up Form (for agencies already using HMIS)

New Agency Set-Up Form (for agencies not using HMIS)

HMIS Overview and Requirements for New Agencies: New to HMIS?  Here’s what to expect (revised 7/11/2017)

Agency Agreement (revised 10/2015)

Inter-Agency Data Sharing Agreement

Agency’s Project Close Out Form

New HMIS User Forms

User Agreement (revised 10/2015)

HMIS Policies and Procedures (updated 10/2015)

Privacy

Protecting Client Confidentiality for Volunteers and Agency Staff (4/1/2016)

Consent To Share Protected Personal Information (revised 10/2015)

Consent To Share Protected Personal Information (Spanish) (4/20/2016)

Note Regarding Collection of Personal Information (revised 10/2015)

Note Regarding Collection of Personal Information (Spanish) (9/2016)

Privacy Notice (revised 10/2015)

Privacy Notice (Spanish) (4/20/2016)

Client Rights Brochure (revised 09/20/2016)

Client Rights Brochure (Spanish) (revised 09/20/2016)

Printing Tips for Client Rights Brochure

Other Documents

HMIS 2017 Agency Audit Form

Client Revocation of Consent to Release Information (revised 10/2015)

Grievance Form

User Revocation of Access Form

HMIS Help Desk Ticket Tracking Spreadsheet