RICoC Request to Replace an Existing VI-SPDAT Electronic Form

RI-Continuum of Care Request to Replace an Existing VI-SPDAT (Including F-VI's and TAY-VI's) in HMIS or Other Comparable Databases

The VI- (VI, F-VI, & TAY-VI) -SPDAT (Service Prioritization Decision Assistance Tool) are assessment tools used for literally homeless persons (18+) that are utilized to determine vulnerability when diversion from homelessness is unsuccessful. There should only be one VI-SPDAT in HMIS or comparable database per client; please refer to the RICoC VI-SPDAT Policy for more information on how/when to administer a VI and when filling out this form may be required.

1. Date of Request *This question is required. This question requires a valid date format of MM/DD/YYYY.

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2. What is the CLIENT ID NUMBER for the client you are requesting a replacement VI-SPDAT for? (NO NAMES) *This question is required. This question requires a valid number format.

3. Requestor Information for Replacement VI-SPDAT *This question is required.

Name of Organization Requesting Replacement
Name of Case Manager Requesting Replacement
Title of Case Manager Requesting Replacement
Email of Case Manager Requesting Replacement
Name of Supervisor that Approved Replacement
Title of Supervisor that Approved Replacement
Email of Supervisor that Approved Replacement

5. Please explain the main reason (selected in the previous answer) as to why you are submitting a replacement VI-Request form. *This question is required.

7. What date was the pre-existing VI-SPDAT completed? *This question is required. This question requires a valid date format of MM/DD/YYYY.

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8. What are the scores for each domain in the pre-existing VI-SPDAT that was already in the system for this client?
*This question is required.

Pre-Survey
A. History of Housing and Homelessness
B. Risks
C. Socilization and Daily Functions
D. Wellness
(Families Only) E. Family Unit
Grand Total

10. What was the date you completed the new VI-SPDAT for this client? *This question is required. This question requires a valid date format of MM/DD/YYYY.

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11. What are the new scores for each domain in the new VI-SPDAT you completed for this client? *This question is required.

Pre-Survey
A. History of Housing and Homelessness
B. Risks
C. Socilization and Daily Functions
D. Wellness
(Families Only) E. Family Unit
Grand Total

12. If you agree that the above form is filled out accurately to the best of your knowledge, please type your full name that will serve as an electronic signature. *This question is required.