HMIS Privacy Documents
Use this agreement if your agency has not signed a sharing agreement (QSOBAA) with other agencies, or if it is a one way sharing partner within a sharing agreement. Only use this document if your agency is not sharing client data you collect with other providers.
Use this agreement if your agency has signed a sharing agreement (QSOBAA) with other agencies, and is a two way sharing partner. There are three sections to this document:
1. Have a client initial the top section next to First and Last Name, Year of Birth, Gender, or SS# if they do NOT want that information visible on the client search screen. (This area does not reveal intake data or services being received.)
2. The middle section concerns intake information collected during the intake interview. If a client agrees to share this information with participating sharing partners, have them initial yes. Otherwise have them initial no. (Specifics on what is shared and which agencies are part of the community-wide sharing QSOBAA can be found in 05-04 Flint-Genesee Sharing Agencies.pdf)
3. The bottom section is where the date of expiration for the ROI is filled in, and the client then signs and dates the form. For short term or services only programs, a expiration date of one year is suitable for the ROI.
Use this ROI in addition to 05-02 if:
a) You are sharing information with other sharing partners on the MSHMIS system and
b) Your client has a documented disability categorized as one of the following: a physical/medical disability, an alcohol abuse/substance abuse condition, a mental health condition, an HIV/AIDS related condition, or is a domestic violence survivor.
If a client has one of the above conditions, you MUST have them complete and sign the second ROI before information on that condition can be shared.
05-04 Flint-Genesee Sharing Agencies.pdf
This form contains a list of the information that is shared within a sharing agreement, and which agencies the information is shared with. Note: this only reflects agencies signed to the Flint/Genesee County Sharing QSOBAA. A copy of this should be presented to each client you see if you are a two-way sharing partner.
05-05 Privacy Notice - Client Copy.pdf
When a client comes in for an intake, present the privacy notice to the client and briefly go over each section as directed in the Privacy Script. A client is entitled to keep a copy of the privacy notice for their own records.
05-06 Privacy Script - Staff Guide.pdf
This is a guide for explaining privacy rights for staff members conducting intake interviews. Staff members should have a copy available to review as they familiarize themselves with the process of explaining a client's rights during an intake.
05-08 Privacy Statement.pdf
The Privacy Statement outlines the Michigan Coalition Against Homelessness' obligations to both clients and participating agencies as the lead agency in the MSHMIS implementation.
05-09 Public Privacy Notice.pdf
Post this notice in waiting areas and intake rooms where HMIS intakes take place. Federal law requires that agencies post this notice as participants in the system.
05-10 Privacy Flow Chart.pdf
This flowchart guides intake staff through the process to complete in explaining a client's privacy rights. It is a great resource to have available while learning to present the privacy notice and releases of information to a client.
|05-01 MSHMIS-ROI-NOSHARING.pdf||[ ]||54 Kb|
|05-02 MSHMIS-ROI-SHARING.pdf||[ ]||49 Kb|
|05-03 MSHMIS-ROI-SHARING-RESTRICTED-INFO.pdf||[ ]||125 Kb|
|05-04 Flint-Genesee Sharing Agencies.pdf||[ ]||64 Kb|
|05-05 Privacy Notice - Client Copy.pdf||[ ]||96 Kb|
|05-06 Privacy Script - Staff Guide.pdf||[ ]||28 Kb|
|05-08 Privacy Statement.pdf||[ ]||77 Kb|
|05-09 Public Privacy Notice.pdf||[ ]||50 Kb|
|05-10 Privacy Flow Chart.pdf||[ ]||14 Kb|