Get Client Consent For Data Collection Shelter Plus ... - St. Lucie County

Filling out the Client Consent For Data Collection Shelter Plus Care form is an essential step in accessing services provided by St. Lucie County. This guide will walk you through the process of completing the form online with clarity and support.

Follow the steps to successfully complete the consent form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor for online completion.
2. Enter your full name in the designated field where it states 'I, ____ (client’s name)'. Ensure that the information is accurate as it will be used for identification purposes.
3. Review the section regarding the agency's affiliation with the homeless management information system (HMIS). Make sure you understand how your information will be used.
4. Read the list of authorizations carefully. Each item corresponds to the types of information being collected. Initial each item to indicate your consent for that specific type of information collection.
5. Indicate the specific purpose for which the data is being collected by selecting one or more options provided, such as 'Further care', 'Evaluation', or another purpose if applicable.
6. Acknowledge your understanding of your rights regarding your records. This includes your right to inspect, copy, and request records maintained by the agency.
7. Read and acknowledge your understanding that you can revoke this consent at any time by signing and dating the revocation. Note that this consent auto-terminates one year after your last treatment or discharge.
8. Confirm your understanding of confidentiality regulations protecting your information. This section clarifies the limitations on disclosing your records without consent.
9. Finally, review the optional nature of participation in data collection and note that you may still access other services if you choose not to participate.
10. Sign and date the form in the provided areas for 'Head of Household Signature' and, if applicable, 'Spouse/Significant Other'. Ensure all signatures are completed before submitting.
11. Once completed, save the changes made to the form, then download or print a copy for your records. You can also share the form with your case manager if required.

Complete your Client Consent Form online today to ensure you receive the support and services you need.