Get Ga Hmis Client Consent To Share Revocation - Dca State Ga

Filling out the GA HMIS Client Consent To Share Revocation form is an essential step for individuals wishing to revoke their consent for information sharing within the Georgia Homeless Management Information System. This guide provides clear, step-by-step instructions to assist users in completing this form accurately while ensuring privacy and understanding.

Follow the steps to successfully complete the revocation form.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing platform.
2. Begin by reading the statement at the top of the form carefully. It outlines the consequences of revoking your consent, including the understanding that previous disclosures will not be affected.
3. In the section labeled 'Client/Legal Guardian Name,' print your full name clearly. Ensure this is the name linked to your existing information in the GA HMIS.
4. Locate the 'DOB' field and enter your date of birth in the specified format. This helps confirm your identity.
5. In the next field, provide the last four digits of your Social Security number. This information further verifies your identity without sharing your full Social Security number.
6. Sign the form in the 'Signature' section, indicating that you have reviewed the form and understand the implications of revoking your consent.
7. Below your signature, write the date to document when you completed the revocation.
8. If you have minor children whose information was previously shared, fill in their names, dates of birth, and the last four digits of their Social Security numbers in the respective fields.
9. Review your completed form for accuracy and completeness before finalizing.
10. Once you have filled in all necessary information, save the changes, and proceed to download, print, or share the form as needed.

Take the necessary step to manage your information—complete the GA HMIS Client Consent To Share Revocation form online today.