Participant Agency and all providers/projects Sample Clauses

Participant Agency and all providers/projects. 2) Limited Participant Agency and only the following providers/projects (a separate form is required for remaining providers/projects): STATIC ELEMENTS Static Elements Includes • Client Name Alias SSN and SSN Data Quality U.S. Military Veteran Age □ Yes, agency will share • Client Demographics Date of Birth Date of Birth Type Gender Race Ethnicity (Hispanic/Latino) □ Yes, Agency will share □ No, Agency cannot share because of regulation □ HIPAA □ VAWA □ 42 CFR □ Other • Entry/Exit Document Clients’ entries and exits to and from a provider’s program, including Community Connect assessment and housing project entry. □ Yes, Agency will share □ No, Agency cannot share because of regulation □ HIPAA □ VAWA □ 42 CFR □ Other • Needs, Services and Referrals Identifies the services provided to Client, referrals made other service providers, track unmet needs. □ Yes, Agency will share □ No, Agency cannot share because of regulation □ HIPAA □ VAWA □ 42 CFR □ Other • Case Manager Name, provider and phone number of identified Case Manager. □ Yes, Agency will share □ No, Agency cannot share because of regulation □ HIPAA □ VAWA □ 42 CFR □ Other ASSESSMENTS Assessments Includes • HUD Universal Data Elements (UDE’s) • Community Connect, which includes: □ Pre-Screening □ Assessment Universal HUD information is included here; sharing reduces the need for subsequent service providers to collect information. Information used to collaboratively determine and see determination of eligibility and referral to program. ⮽ Yes, Agency will share • Housing Assessment for Entry/Exit Provider Agency intake screening for programs in Washington County. □ Yes, Agency will share □ No, Agency cannot share because of regulation □ HIPAA □ VAWA □ 42 CFR □ Other • Household Data Sharing Assessment Information that applies to all Head-of-Household (HH) members and are considered UDEs or community essential. □ Yes, Agency will share □ No, Agency cannot share because of regulation □ HIPAA □ VAWA □ 42 CFR □ Other • Outcome Assessments Washington County Provider shared outcomes for HUD mandated System Performance Measurements (SPM), and local benchmarks. □ Yes, Agency will share □ No, Agency cannot share because of regulation □ HIPAA □ VAWA □ 42 CFR □ Other • One Night Homeless Count Assessments Information needed for HUD mandated Point-In-Time Counts. □ Yes, Agency will share □ No, Agency cannot share because of regulation □ HIPAA □ VAWA □ 42 CFR □ Other • • Other Assessment Agency Chooses, listed to...