TLP, PSH, Shelter+Care Family Discharge Form Applicant (Head of Household) Information: First Name: ___________________________ Last Name: __________________________ Client ID#: ____________________ Project Exit Date: Case Manager Assigned to Discharge: _____________________ _____________________ Relationship to Head of Household Member Name HMIS ID# Date of Birth Gender Household Self
TLP, PSH, Shelter+Care Family Discharge Form Applicant (Head of Household) Information: First Name: ___________________________ Last Name: __________________________ Client ID#: ____________________ Project Exit Date: _____________________ Case Manager Assigned to Discharge: _____________________ Household Member Name Date of Birth Gender Relationship to Head of Household HMIS ID# Self