Homeless Management Information System (HMIS)

The Contra Costa Homeless Continuum of Care utilizes a web-based Homeless Management Information System (HMIS) which helps gives our collaboration of homeless agencies a better way to collect data, coordinate care, and manage operations. The HMIS can be used to produce an unduplicated count of homeless persons, understand patterns of service use, and measure the effectiveness of homeless programs in Contra Costa County .If your program serves homeless individuals or families and you would like to become an HMIS partner agency, please contact homelessprogram@cchealth.org.

Service Provider Forms

• Client Release of Information (ROI) Authorization and List of Partner Agencies:
  • Client Release of Information (ROI) Authorization (English) 1.23.24
  • Client Release of Information (ROI) Authorization (Spanish) 1.23.24
  • Client Release of Information (ROI) Authorization (Chinese Simplified)
  • Client Release of Information (ROI) Authorization (Chinese Traditional)
  • Client Release of Information (ROI) Authorization (Lao)
  • Client Release of Information (ROI) Authorization (Russian)
  • Client Release of Information (ROI) Authorization (Tagalog)
  • Client Release of Information (ROI) Authorization (Vietnamese)
• Benefits of signing the HMIS ROI 8.16.17
• Standard Forms:
  • HMIS Intake Form10.3.23
  • HMIS Exit Form 9.21.23
  • HMIS Update Form 9.21.23
  • HMIS Intake Form for CE Access Points 9.21.23
• Runaway and Homeless Youth:
  • Runaway and Homeless Youth Intake Form 9.21.23
  • Runaway and Homeless Youth Exit Form 9.21.23
  • Runaway and Homeless Youth Update Form 9.21.23
  • Runaway and Homeless Youth Aftercare Form 9.21.23
• CORE Mobile Outreach:
  • CORE Mobile Outreach Intake Form 9.21.23
  • CORE Mobile Outreach Child Intake Form 9.21.23
  • CORE Mobile Outreach Youth Intake 9.21.23
  • CORE Mobile Outreach Contact Sheet 3.4.21
  • CORE Mobile Outreach Supplemental Sheet for Non-homeless 10.2.19
• HDAP:
  • HDAP Intake Form 9.21.23
  • HDAP Update Form 9.21.23
  • HDAP Exit Form 9.21.23
• Warming Center and Service Center Intake11.1.23
• H3 Warming Center/Service Center Intake 9.27.21
• Respite Exit

Data Management Policies

• HMIS Data Quality Monitoring Plan 3.1.24
• HMIS Exit Destination Guide
• Privacy Notice:
  • HMIS Privacy Policy (English)
  • HMIS Privacy Policy (Spanish)
  • HMIS Privacy Policy (Chinese Simplified)
  • HMIS Privacy Policy (Chinese Traditional)
  • HMIS Privacy Policy (Lao)
  • HMIS Privacy Policy (Russian)
  • HMIS Privacy Policy (Tagalog)
  • HMIS Privacy Policy (Vietnamese)
• Client Revocation Form:
  • Client Revocation Form (English)
  • Client Revocation Form (Spanish)
  • Client Revocation Form (Chinese Simplified)
  • Client Revocation Form (Chinese Traditional)
  • Client Revocation Form (Lao)
  • Client Revocation Form (Russian)
  • Client Revocation Form (Tagalog)
  • Client Revocation Form (Vietnamese)
• HMIS Governance Charter and HMIS Policies & Procedures 3.1.24
• HMIS Data Collection Guide
• How to Run and Tips to Correct the Monthly Enrollment Reports
• Clarity User's Manual

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