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CA Santa Clara County HMIS Client Consent to Data Collection and Release of Information 2020 free printable template

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CLIENT CONSENT TO DATA COLLECTION AND ROI Page 1 of 6SANTA CLARA COUNTY HIS CLIENT CONSENT TO DATA COLLECTION AND RELEASE OF INFORMATIONTHIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED
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How to fill out CA Santa Clara County HMIS Client Consent

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Start by obtaining the CA Santa Clara County HMIS Client Consent form from the appropriate source.
02
Read the instructions carefully to understand the information required and the consent process.
03
Fill in your personal details, including your name, address, and contact information in the designated fields.
04
Review the sections regarding data sharing and the purpose of data collection to ensure clarity.
05
If applicable, indicate any third parties with whom your information may be shared.
06
Sign and date the form to indicate your consent to the terms outlined.
07
Keep a copy of the consent form for your records.

Who needs CA Santa Clara County HMIS Client Consent?

01
Individuals seeking services from homeless assistance programs in Santa Clara County.
02
Service providers who need to document and share client data for coordination of care.
03
Organizations participating in the Homeless Management Information System (HMIS) that require client consent for data collection and sharing.
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CA Santa Clara County HMIS Client Consent is a document that grants permission for client information to be collected, stored, and shared in the Homeless Management Information System (HMIS) by service providers operating in Santa Clara County.
Clients receiving services from homeless service providers in Santa Clara County are required to file the CA Santa Clara County HMIS Client Consent.
To fill out the CA Santa Clara County HMIS Client Consent, clients should read the consent form carefully, provide accurate personal information, and sign and date the document to indicate their consent for the use of their information.
The purpose of the CA Santa Clara County HMIS Client Consent is to ensure that clients are informed about the collection and sharing of their personal information and to obtain their explicit permission, thereby promoting transparency and protecting client privacy.
The information reported on the CA Santa Clara County HMIS Client Consent typically includes the client's name, date of birth, contact information, the services being received, and the client's consent to share their data with specific agencies involved in their care.
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