Get Client Consent To Data Collection And Roi - Santa Clara County ... - Scc Hmis

Filling out the Client Consent To Data Collection and ROI form is an essential step for accessing services related to homelessness in Santa Clara County. This guide provides clear, step-by-step instructions to help you complete the form efficiently and accurately.

Follow the steps to complete your consent form online.

1. Click the ‘Get Form’ button to access the Client Consent To Data Collection and ROI form and open it for editing.
2. Review the introduction section carefully. It outlines how your information may be used and disclosed. Ensure you understand the purpose of the form before proceeding.
3. In the authorization section, you will need to agree to the collection, use, and sharing of your information. Initial next to the types of protected personal information (PPI) and protected health information (PHI) you consent to share. You can choose specific types or all listed categories.
4. Complete any additional personal information required in the designated fields, such as your name, birth date, and contact details, ensuring accuracy.
5. For the expiration date of consent, insert the date when your authorization will no longer be valid. If you leave this blank, the form will not be valid.
6. Sign the form at the designated area acknowledging your consent and understanding of terms. If applicable, have a representative sign and indicate their relationship to you.
7. After completing the form, save changes, and consider downloading, printing, or sharing the document as needed.

Complete your Client Consent To Data Collection and ROI form online today to access essential services!