Sample Release of Information

Sample Release of Information

This article contains a sample of the Release of Information Form currently required by the Delaware Continuum of Care. Agency Partners can use this sample as a template to create their own Release of Information, and edit it around their programs' guidelines and protocol.

Important information that must remain in all Release of Information forms:
  1. The client's information is being collected and entered into CMIS.
  2. By providing consent, the client's information is being shared with other providers utilizing CMIS for the purposes of service coordination.
  3. All CMIS data shared outside of participating Agencies is done so through aggregated data that does not contain identifiable information.
  4. Clients have the right to request, review, and have their information removed from CMIS.
  5. Clients cannot be denied services if they choose to not sign an ROI.
Agency-level guidelines and protocol must not contradict DE-CMIS Policies and Procedures.

Attached this article is the most recent version of Housing Alliance Delaware's Sample ROI.

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