Get Contra Costa Rhy Hmis Intake Form 12-4-15.doc - Cchealth

This guide offers a detailed, step-by-step approach to completing the Contra Costa RHY HMIS Intake Form 12-4-15. Following these instructions will help ensure that users can accurately and effectively provide their information as required.

Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to access the Contra Costa RHY HMIS Intake Form and open it in your preferred editor.
2. Begin by entering the intake date, intake counselor's name, and the program name in the designated fields at the top of the form.
3. Fill in your personal information, including first name, middle name, last name, suffix, date of birth, age, and social security number. Ensure all dates are entered in the correct format.
4. Review the authorization section. Confirm understanding of how your personal information may be shared, and provide your printed name, signature, and date.
5. Indicate if an interpreter was used during the intake process, and if required, specify the language the participant is most comfortable using.
6. Provide information about sexual orientation and gender identity by selecting the appropriate options from the listed categories.
7. Detail your current housing status. Select from the categories provided, which reflect your current living situation, such as 'homeless' or 'stably housed.'
8. Fill out sections regarding your last permanent residence and current address, ensuring accuracy in the city and zip code fields.
9. Indicate where you slept last night, and where you lived prior to entering the program. Provide as much detail as possible for accurate record-keeping.
10. Complete the sections related to previous living situations, homelessness history, and the total length of time you have been homeless.
11. Answer all questions about your military service status, education history, disabilities, and current health status as honestly and thoroughly as possible.
12. Provide information on income if applicable and detail your employment history, including any training programs you may be involved in.
13. Before submitting the form, review all entries for accuracy. Make any necessary edits or corrections.
14. Once everything is filled out and reviewed, save your changes. You can then choose to download, print, or share the completed form as needed.

Complete the Contra Costa RHY HMIS Intake Form online to ensure access to essential services.