HMIS
Please email the below HMIS forms to: HMIS@stancounty.com
HMIS Report Data Request Form
HMIS Report Data Request FormHMIS Project & Grant Set Up Forms
HMIS Project Set Up FormHMIS Grant Set Up Form
HMIS Bed & Unit Inventory Update Form
HMIS User Access Request Form
New User Request FormUser Policy Responsibility Statement
HMIS Client Consent & ROI
Client Informed Consent & Release of Information (English)Client Informed Consent & Release of Information (Spanish)
HMIS CES Verification Form
HMIS Coordinated Entry System Verification FormUser Data Entry Manual
User Data Entry ManualHMIS PIT/HIC Forms
Housing Inventory Count (HIC)Annual or Update Forms
Outreach Universal Program Update FormPATH Program Update Form
Universal Program Update Form
Assessments
CES Triage AssessmentSelf-Sufficiency Matrix
VI-SPDAT for Families
VI-SPDAT for Single Adults
VI-SPDAT Transition Age Youth (ages 13-24)
Exit Forms
Child Program Exit Form- All ProgramsPATH Program Exit Form
RHY Program Exit Form
RHY Outreach Exit Form
SSVF Program Exit Form
Universal Exit Form
Universal Outreach Exit Form
Intakes
Child Program Intake Form - All Programs with CESCoC, ESG, Private Funded Intake Form For Persons Entering a Shelter
CoC, ESG, Private Funded Intake Form For Persons Entering a Shelter with CES
CoC, ESG, Private Funded Intake Form For Persons Entering Transitional Housing, Any Permanent Housing, Rapid Re-housing, or Homeless Prevention with CES
Coordinated Entry Program Intake Form
PATH Program Intake Form with CES
RHY Program Intake Form with CES
RHY Outreach Program Intake Form
SSVF Program Intake Form
Universal Outreach Program Intake Form
VA GPD Program Intake Form with CES
Current Living Situation
Current Living Situation FormUniversal Outreach Contact Form
HMIS Policies & Procedures
HMIS Policies and Procedures [PDF]HMIS Policies & Procedures Documents
Agency Access ApplicationBaseline Model Privacy Notice for CHO (Individual Agencies)
Client Denial of HMIS Consent
Client HMIS Grievance Form
Client Informed Consent and Release of Information
Client Informed Consent and Release of Information - Spanish
Client Privacy Rights
Client Revocation of HMIS Consent
Consumer Notice (Version 1)
Consumer Notice (Version 2)
HMIS Fee Schedule
HMIS MOA
HMIS Participating Agencies
HMIS Security Standards
HMIS Mandatory Data Collection Notice
Partner Agency Administrator Agreement
Stanislaus County Data Quality and Security Audit Form
Welcome to ClientTrackNET
HMIS Participating Agencies – Updated August 21, 2023
HMIS Participating Agencies [PDF]- (BHRS) Stanislaus County Behavioral Health & Recovery Services
- (CCD) Catholic Charities Diocese of Stockton
- (CHS) Center for Human Services
- (CHSS) Community Housing and Shelter Services
- (CICV) Community Impact Central Valley
- City of Modesto
- (CSA) Community Services Agency
- (DRAIL) Disability Resources Agency for Independent Living
- (DST) Downtown Streets Team
- (FP) Family Promise
- (HEART) Homeless Engagement and Response Team
- (HOST) Host House/Cambridge Academies
- (HA) Stanislaus Regional Housing Authority
- (HN) Health Net Community Solutions Inc./California Health & Wellness
- (HPSJ) Health Plan of San Joaquin
- (MGM) Modesto Gospel Mission
- Outreach and Engagement Center
- City of Riverbank
- Salvation Army
- (SAN) Senior Advocacy Network
- (STANCO) Stanislaus County Affordable Housing Corp
- Stanislaus County CARE
- Stanislaus County Department of Planning
- (TGM) Turlock Gospel Mission
- Turning Point Community Programs
- United Samaritans Foundation
- We Care Program Turlock
- West Care San Joaquin Valley Veterans
For HMIS questions or concerns please email: HMIS@stancounty.com
HMIS Team
- Lynnell Fuller, HMIS Administrator
- (209) 558-3676
- HMIS@stancounty.com
Copyright © Stanislaus County, California 2022
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