Housing Intake – Client Privacy Policy Form Client Privacy Policy Form Client Privacy Policy Form Housing Intake - Client Privacy Policy FormAt HopeLink of Southern Nevada, we respect the privacy of all clients participating in the Rapid Rehousing program. We are committed to protecting the personal information you provide to us and ensuring it is handled safely and confidentially. 1. Information Collected We may collect the following information to provide housing and supportive services: Personal identification (name, date of birth, social security number, etc.) Contact information (address, phone, email) Household information (family members, income, housing status) Health or disability-related information (if necessary for accommodation) Case notes and program records HMIS (Homeless Management Information System) data: Your information will be entered into the HMIS database to help coordinate services across agencies. 2. Use of Information Information you provide is used only for: Determining eligibility for Rapid Rehousing services Providing case management and supportive services Reporting to funders as required by law (e.g., HUD, local agencies) Program evaluation and improvement Coordinating services through the HMIS database 3. Confidentiality All client information is treated as confidential. Information will only be shared with your consent or as required by law. Staff are trained to protect client privacy and comply with HIPAA, HUD, HMIS, and other applicable privacy laws 4. Sharing Information Your information may be shared with: Program staff for case management Partner agencies provide services as part of your housing plan with your consent. Funders or oversight bodies, in aggregate or de-identified form whenever possible. Authorized users of the HMIS database for service coordination. 5. Your Rights You have the right to review your own records. You have the right to request corrections to your information. You may request restrictions on how your information is used or shared. 6. Security Measures Hopelink uses physical, electronic, and procedural safeguards to protect your personal information from unauthorized access, disclosure, or misuse, including HMIS data security protocols. 7. Contact If you have questions about this privacy policy or wish to exercise your privacy rights, please contact: Tiffany Simmons – Director of Housing ServicesPhone: 702-566-0576 ext. 1004Email: Tiffany@link2hope.orgAcknowledgement I have received and reviewed the Privacy Policy for the Rapid Rehousing program. I understand how my information will be collected, used, and protected. I know my rights regarding my personal information.Client Name SignatureFirst NameMiddle NameLast NameDateClient Name SignatureFirst NameMiddle NameLast NameDateSubmit Form