Clarity Agency Set-Up Form
This form should be completed by an organization that is interested in joining Rhode Island HMIS only after the successful submission of a Partnership Agreement and, if applicable, a Business Agreement (for HIPPA covered entities).
Agency Name *
Is your organization a nonprofit, 501(c)3 organization? *
Is your organization a HIPAA covered entity? *
Please explain the overall mission of your organization and how you work with those at-risk or experiencing homelessness. *
Name of Person Requesting HMIS Access *
Email Address *
Title *
Phone Number *
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