Client Intake

Client Intake

Intake data entry for Non-HMIS PL

Client ID*

Please follow CoC policies for creating client ID's. CoC Non-HMIS Access Point Policy. If you are not established with an Agency Code yet, Please contact Support@moboscoc.org with the Subject: "Non-HMIS provider code."

Current Status*

Select or enter value

Housing Referral Made (active)*

Client has an active referral from Case Conferencing to a housing project (please do not include non-housing referrals).

Select

CE ROI Expiration*

Please ensure you have this information on file with Client Name and Client ID listed

Relationship to HoH*

Prioritization List Start date*

Provider adding client to the PL*

The name of the organization responsible for maintaining records and ongoing case management.

Intake Staff*

Please include contact information separated by commas.

"Name, Phone, Email"

Data Entry Staff Contact*

This contact will receive update requests for data entry. Please provide the preferred email address to maintain client records properly.

VI Type*

Select

VI Score

Fleeing DV?*

Select

Chronic*

Select or enter value

Prior Living Situation*

This should represent where the client stayed immediately prior to the Coordinated Entry Assessment (i.e. where did they sleep last night?).

Select

Current Living Situation*

This should represent where the client is currently staying (i.e. where will they sleep tonight?).

Select or enter value

Length of stay in Prior Living Situation*

Select

Approximate date when Homelessness started*

Number of Times Homeless

Months Homeless at Assessment

Current County*

Select

Current Region

Willing to Relocate*

Select

County list*

Please use this field to indicate ALL counties in which the client would like to be considered for housing. If client is not willing to relocate, include the current county here.

Select

🛑 STOP 🛑

Please ensure the county list above includes all counties the client is seeking housing in, INCLUDING THE CURRENT COUNTY.

If the county list is correct, you may continue

Number of clients in household

Age

Gender*

Select

Sex Offender*

Select

Vet Status*

Select

Disability?*

Select

Return From Inactive

Select

Last Inactive Date

If client was previously on the Prioritization List.

Return From Housed

If client was previously housed by the Prioritization List.

Last PL Removal Date when Housed

If client exited the Prioritization List into a housing provider with referral.

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