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Intake for Domestic Violence Providers Basic Client Information First Name:* Last Name:* Middle Name: Suffix: Social Security Number:* Don't Know or Don't Have RefusedMarital Status: Single Divorced
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To fill out the Contra Costa Standardized HMIS form, follow these steps:
02
Start by gathering all relevant information about the client for whom you are filling out the form.
03
Begin with filling out the basic demographic information of the client, such as name, age, gender, race, and ethnicity.
04
Provide information about the client's current living situation, including their housing status and any support services they are receiving.
05
Document the client's history of homelessness or housing instability, including the duration and frequency of episodes.
06
Include information about the client's income, employment status, and any benefits they are receiving.
07
Record the client's history of mental health, substance abuse, and physical health conditions, as well as any access to healthcare services.
08
Document any support services the client is currently receiving or may need in the future, such as case management, counseling, or housing assistance.
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Finally, review the completed form for accuracy and completeness before submitting it to the appropriate organization or agency.

Who needs contra costa standardized hmis?

01
Contra Costa Standardized HMIS is needed by organizations and agencies that provide housing and support services to individuals and families experiencing homelessness and housing instability.
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These organizations include homeless shelters, outreach programs, transitional housing providers, and social service agencies.
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By using the Standardized HMIS form, these organizations can collect and analyze data to better understand the needs of their clients, track outcomes, and allocate resources effectively.
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Contra Costa Standardized HMIS is a system used to collect and store data on homeless individuals and families in Contra Costa County.
Service providers and agencies that receive funding from HUD and participate in homeless assistance programs are required to file Contra Costa Standardized HMIS.
To fill out Contra Costa Standardized HMIS, service providers and agencies must input the necessary data on homeless individuals and families using the designated software system.
The purpose of Contra Costa Standardized HMIS is to track and monitor homeless populations, assess needs, and allocate resources effectively to provide assistance and support.
Information such as demographics, housing status, service needs, and outcomes must be reported on Contra Costa Standardized HMIS.
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