Wisconsin Homeless Management Information System (HMIS)
Client Release of Information
As a partner agency of the Wisconsin Homeless Management Information System (HMIS), The Salvation Army of La Crosse, Wi has agreed to mutually share information with other Wisconsin HMIS partner agencies about individuals and families that seek housing services in Wisconsin. This information will be shared through the Homeless Management Information System (HMIS) in order to coordinate and improve programs and services.
To make sure that you are not counted in the system twice, we need your name, birth date, gender, race and last permanent address. Only non-identifying information will be entered for clients currently fleeing or in danger from a domestic violence, dating violence, sexual assault or stalking situation. HMIS data will also be shared with the HMIS Lead Agency, the Institute for Community Alliances, and combined with data for the purpose of further analysis. Your name and other identifying information will NOT be included in ANY reports or publication. The information will be stored for a minimum of seven years.
All agencies participating in Wisconsin’s HMIS will guard your personal information with strict security policies to protect your privacy. HMIS software is highly secure and uses up-to-date protection features such as data encryption, passwords, and identity checks required for each system user. There are no reasonably foreseeable risks associated with participation in HMIS. However, if you ever suspect the data in HMIS has been misused, immediately contact the HMIS System Administrator at email@example.com.
Your decision to participate in HMIS will not affect the services you are able to receive from this agency or other Wisconsin HMIS partner agencies. However, if you do choose to participate, the information you provide may be used to improve services in our community.
Additional agencies may join Wisconsin’s HMIS and will have access to your information based on this authorization. Upon request, you are entitled to a copy of a list of current Wisconsin HMIS partner agencies before signing the release and anytime thereafter. You may withdraw your consent to releaser your personal information at any time.