HMIS
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Please email the below HMIS forms to: HMIS@stancounty.com
HMIS Project & Grant Set Up Forms
HMIS Grant & Project Set Up FormHMIS Bed & Unit Inventory Update Form
HMIS User Access Request Form
New/Delete User Request FormUser Policy Responsibility Statement
HMIS Client Consent & ROI
Client Informed Consent & Release of InformationHMIS CES Verification Form
HMIS Coordinated Entry System Verification FormHMIS PIT/HIC Forms
Housing Inventory Count (HIC)Annual or Update Forms
Children Program Update FormOutreach Universal Program Update Form
PATH 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 ProgramsCoC, 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, Homeless Prevention, or Day Shelter
CoC, ESG, Private Funded Intake Form For Persons Entering Transitional Housing, Any Permanent Housing, Rapid Re-housing, Homeless Prevention, or Day Shelter with CES
Coordinated Entry Program Intake Form
PATH Program Intake Form
RHY Program Intake Form
RHY Outreach Program Intake Form
SSVF Program Intake Form
Universal Outreach Program Intake Form
Current Living Situation
Current Living Situation FormHMIS Client Consent & ROI
Client Informed Consent & Release of InformationAnnual or Update Forms
Outreach Universal Program Update FormChildren Program Update Form
Universal Program Update Form
Assessments
Self Sufficiency MatrixHMIS Triage Assessment
VI-SPDAT for Families
VI-SPDAT for Single Adults
VI-SPDAT Transition Age Youth (ages 13-24)
Exit Forms
Child Program Exit Form- All ProgramsRHY Program Exit Form
RHY Outreach Exit Form
SSVF Program Exit Form
Universal Exit Form
Universal Outreach Exit Form
Intakes
Child Program Intake Form - All ProgramsCoC, 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, Homeless Prevention, or Day Shelter
CoC, ESG, Private Funded Intake Form For Persons Entering Transitional Housing, Any Permanent Housing, Rapid Re-housing, Homeless Prevention, or Day Shelter with CES
Coordinated Entry Program Intake Form
RHY Program Intake Form
RHY Outreach Program Intake Form
SSVF Program Intake Form
Universal Outreach Program Intake Form
Current Living Situation
Current Living Situation FormData Entry Guides
New User Quick Reference GuideUser Data Entry Manual
Data Quality Guides
How to Run DQ ReportsFixing Common DQ Errors
HMIS Policies & Procedures
HMIS Policies and Procedures [PDF]HMIS Policies & Procedures Documents
Baseline 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 Privacy Rights - Spanish
Client Revocation of HMIS Consent
Consumer Notice (Version 1)
Consumer Notice (Version 2)
Consumer Notice (Version 2) - Spanish
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
HMIS Data Quality Management Plan
HMIS Data Quality Management Plan [PDF]Coordinated Entry System Policies and Procedures
Coordinated Entry System Policies and Procedures Manual [PDF]HMIS Participating Agencies – Updated December 05, 2024
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
- Lutheran Social Services of Northern California
- (MGM) Modesto Gospel Mission
- Modesto Homekey, LP
- 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
- (SHARE) Stanislaus Homeless Advocacy and Resource Enterprise
- (TGM) Turlock Gospel Mission
- Turning Point Community Programs
- United Samaritans Foundation
- We Care Program Turlock
- West Care San Joaquin Valley Veterans
- (YCCD) Yosemite Community College District
For HMIS questions or concerns please email: HMIS@stancounty.com
HMIS Report Data Request Form
HMIS Report Data Request FormHMIS Report Data Request Form - Spanish
HMIS Data
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