HMIS New Provider Set up

Use this form to request a new provider set up in DC's HMIS. Please allow 1 week from completed submission for the set up to be completed. If you have questions, contact the HMIS Helpdesk at hmis@community-partnership.org

Email Address

This is the email address of the person completing this form

Name of Agency

If your agency does not appear in this list please contact HMIS@community-partnership.org

Name of Program

Address of Program (including zip code)

Type of Address provided

Program's Point of Contact Name

This is the person we will contact with any questions about the program including but not limited to vacancies, grant information, and CAHP participation.

Program's Point of Contact email address

Date program began serving clients/will begin serving clients

mm/dd/yyyy

Population Served

If your program will serve more than one of these options, we will likely need to create multiple providers in HMIS. Complete this form for each population you will serve with this program. Contact HMIS@community-partnership.org with questions.

Program Type

If you are unsure what type your program is please refer to this definition document: https://drive.google.com/open?id=1Ny7BSpkjJu1_1CFJgGCP-7XkUGEMnE4V

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