This form of consent is used for housing and homeless services, which permits sharing of a client's personal and individual information (PII) with other service providers who aid clients. It is mandatory for any usage or disclosure that is not included in the agency's privacy notice. Certain organizations may mandate the collection of this form from all clients.
Clients sign this form to revoke their consent to share data outside of the HMIS-covered network. Any changes will take effect as of the date the form is signed, and any data or information shared before that time cannot be recalled.
Please see the Participating Organizations within Alameda County HMIS. All or some of the projects in these agencies participate in the Alameda County HMIS.