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Forms

1. Acknowledgment of Data Collection and Consent to Share
2. HMIS Forms
- 2.1. HMIS Forms for Balance of State and Mahoning CoCs
3. New Project Form
- 3.1. New Project Form
4. Resources
- 4.1. List of HMIS Resources

1. Acknowledgment of Data Collection and Consent to Share

1.1. Data Privacy Notice, Acknowledgment, and Consent

This document contains the following components:

Staff Instructions

Client Rights Information

In-Person Acknowledgment of Data Collection and Consent to Share

Verbal Acknowledgment of Data Collection and Consent to Share

Posted Data Privacy Notice

Clients should complete the Acknowledgment of Data Collection and Consent to Share before their information is entered in HMIS. Clients should complete this form yearly. A verbal (over the phone) version is available on Page 4 of this document.

The Posted Data Privacy Notice must be displayed in your agency's client intake area.

Please email feedback, suggestions, or new form requests to hmis@cohhio.org.

1.2. Data Privacy Notice, Acknowledgment, and Consent - Spanish

This document contains the following components:

Staff Instructions

Derechos de Clientes (Client Rights)

Reconocimiento de Recolección de Datos y Consentimiento para Compartir Datos (Acknowledgment of Data Collection and Consent to Share)

Aviso de Privacidad de Datos (Data Privacy Notice)

Clients should complete the Acknowledgment of Data Collection and Consent to Share (Reconocimiento de Recolección de Datos y Consentimiento para Compartir Datos) before their information is entered in HMIS. Clients should complete this form yearly. A verbal (over the phone) version is nto avilable in Spanish.

The Posted Data Privacy Notice must be displayed in your agency's client intake area. A Spanish version of this notice is available on Page 4 of this document.

Please email feedback, suggestions, or new form requests to hmis@cohhio.org.

1.3. List of Active Agencies

Upon request, any client may be provided with a list of agencies who share data in HMIS (ServicePoint). This list is updated annually. Please direct questions about this list to hmis@cohhio.org.

2. HMIS Forms

2.1. HMIS Forms for Balance of State and Mahoning CoCs

The forms available on this page have been created by COHHIO for use by the Balance of State CoC and the Mahoning CoC.

Please remember to enter the client data collected you record on these forms within five days of the client's intake, update, referral, or exit.

The forms here are in Microsoft Word format (.docx) so that they may be modified if necessary.

Please email feedback, suggestions, or new form requests to hmis@cohhio.org.

3. New Project Form

3.1. New Project Form

NEW PROJECT FORM

The New Project Form is to be used to notify COHHIO that a new homeless dedicated project is beginning or has begun to serve clients in the Ohio Balance of State Continuum of Care (BoSCoC) or Mahoning County CoC. For HMIS-participating new projects, the Agency Administrator should submit this form whenever a new project begins to serve clients. HMIS non-participating projects should also submit this form when the project begins to serve clients.

OHIO BALANCE OF STATE COC PROJECTS

Please send this form plus the HIC Verification Report (if necessary) to ohioboscoc@cohhio.org. Upon approval by Ohio BoSCoC staff, the HMIS team will update HMIS.

MAHONING COUNTY COC PROJECTS

Please send this form plus the HIC Verification Report (if necessary) to colleen.kosta@mahoningcountyoh.gov. Upon approval by the Mahoning County CoC, the COHHIO HMIS team will update HMIS.