Sample Forms

• General Clarity Human Service HMIS Project Intake Forms for All Projects (Not NV Specific)
• General Clarity Human Service HMIS Status Update Forms for All Projects (Not NV Specific)
• General Clarity Human Service HMIS Project Exit Forms for All Projects (Not NV Specific)
• HMIS Intake Desk Sign (PDF): Must be clearly posted at all client intake locations.
• Sample Basic Intake Form (PDF): Captures Universal Data Elements required for each client and collected on the Profile screen.
• SOAR data fields captured at Entry and Exit: Basic SOAR workflow and data fields collected at both Entry and Exit.

Client Privacy Protection & Data Confidentiality Forms 

Clients MUST be given a notification and consent form that explains HMIS and why their personal information is being collected. An HMIS Intake Desk Sign must also be clearly posted at all locations where Client Intake is handled.

If data is to be shared with other agencies, clients are also given a release of information (ROI) form which they must sign or verbally agree to. Our Client Consent Form combines Client Consent and Release of Information into a single document.

Links to forms and instructions are in the area below.

Your agency can modify the “Client Forms” to fit your particular situation, but you are encouraged to seek legal counsel before doing so. They are designed to meet legal requirements and to provide clear information to the clients.

Agencies are responsible for arranging translation services for their clientele. One possible resource is http://www.languageline.com