HMIS Forms

Since its inception in 2004, BTG has utilized the HMIS to collect client-level data, as well as data on the provision of housing and services to at-risk and homeless individuals and families. BTG’s HMIS application enables homeless service organizations to improve case management by collecting information about client needs, goals, and service outcomes and allows for timely access to resources and prioritized referral information to better manage coordinated entry operations. The following forms are essential to compliance with client confidentiality and data security requirements, HUD Data Standards, PATH, and CES referral prerequisites.

HMIS Consent Forms

Confidentiality of client information is of utmost importance in data collection. The following consent forms and policy documents support specific confidentiality and security standards to protect and inform both the client and provider.

BTG Custom Data or Report Request Form

This form can be used to request ad hoc analysis or to develop new custom reports or dashboards. Before a request is made, please review the reports page of this website and the set of existing reports that are currently available in the system. KMNH has developed an extensive collection of reports and dashboards that may already meet your needs. All requests are subject to review by KMNH and the BTG BOD to assess complexity, feasibility, and to ensure that BTG’s privacy standards are upheld. Approval of data requests and applicable fees will be determined by the BTG BOD.

HMIS Privacy Policy Documents

The Statewide HMIS Data Committee and HMIS Lead recently approved the use of a new HMIS consent to share form.  Effective Wednesday, July 5, 2017, all Homeless Providers contributing data into HMIS are required to use this new form.

HMIS User Forms

The following forms must be completed and submitted to the HMIS admin team if new users require access to the system or if duplicate clients require merging. Please note that the training request form will need to be submitted along with the new user agreement form.

HUD Documents

The HUD HMIS Data Standards are the foundation of an HMIS. BTG has chosen CaseWorthy as its HMIS solution. The following HUD documents are available for download to help navigate and better understand HMIS data collection. The FY 2022 HMIS Data Standards have an effective date of 10/1/2021.

PATH HMIS Documentation

The Projects for Assistance in Transition from Homelessness (PATH) Program participation in HMIS provides a platform for coordinating care and improving access to mainstream programs and housing resources and supports the generation of the PATH Annual Report. Guidance included in the following documents aligns with HMIS requirements as stated by the Substance Abuse and Mental Health Services Administration (SAMHSA):

The following entry/assessment and corresponding exit forms are intended to capture specific program requirements in each category: adults, youth and children.

HMIS Enrollment Forms

HMIS Exit Forms


The Vulnerability Index Service Prioritization Decision Assistance Tool (VI-SPDAT) was developed by OrgCode Consulting and is a triage survey administered to homeless individuals and families that helps to determine acuity of need and prioritization of BTG's housing resources and supportive services.

Bridging The Gap (BTG) VI-SPDAT V3 Forms

The Service Prioritization Decision Assistance Tool (SPDAT) was developed by OrgCode Consulting as an assessment tool for frontline workers to prioritize which homeless clients should receive assistance first and to determine when clients have sufficiently stabilized so that assistance is no longer needed.

Bridging The Gap (BTG) SPDAT Forms


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