Get Stanislaus County Hmis Client Informed Consent And Release - Stancoha

Filling out the Stanislaus County HMIS Client Informed Consent and Release Form can seem daunting, but with clear guidance, it can be a straightforward process. This guide will walk you through each section of the form to ensure you can submit it online with confidence.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to access the Stanislaus County HMIS Client Informed Consent and Release form in the online editor.
2. Review the introductory section that explains the purpose of the form. This will help you understand how your information will be used within the Stanislaus Housing and Support Services Collaborative.
3. Fill in the name of the agency from which you are requesting or receiving services in the designated space. This is typically found at the top of the form.
4. In the section detailing the information you authorize to be entered into the HMIS, clearly provide your identifying information such as your name, social security number, date of birth, gender, ethnicity, marital status, household relationships, phone numbers, and address.
5. Next, fill out the section regarding the information you authorize to be entered but not shared between agencies. This includes basic information about any disabilities, veteran status, general health, education, employment status, homeless status, housing information, and financial information.
6. If applicable, indicate details about any disabling conditions, domestic violence status, program entry, exit dates, services rendered, and destination after program exit.
7. Read the statements regarding your rights surrounding the authorization, including the ability to cancel consent and view your HMIS record. Ensure you understand these rights before proceeding.
8. Provide your signature in the designated area to authorize the release of your information. Ensure that your printed name and the date are included accurately.
9. Once you have filled out all required fields, save the changes made to your form. You may also have options to download, print, or share the completed form as needed.

Take the next step towards accessing services by completing the Stanislaus County HMIS Client Informed Consent and Release Form online now.