Forms
Assistive Technology: DDW (Budget-Based) Fund Application and Instructions (1-5-2023 version)
Clinical Services - Form
January 12, 2023
Assistive Technology: Budget-Based ATF Fund Application Form - (fillable)
Medically Fragile (MF) Waiver Provider Application
DD & Medically Fragile Waiver Provider Enrollment - Form
January 10, 2023
Medically Fragile (MF) Waiver Provider Application
Medically Fragile (MF) Waiver Provider Application Forms
DD & Medically Fragile Waiver Provider Enrollment - Form
January 10, 2023
Medically Fragile (MF) Waiver Provider Application Forms
Medical Cannabis Patient Application
Medical CannabisEducational Materials, Resources, Publications and Archives - Form
January 9, 2023
The application for first time and returning patients is the same. Please complete this form and submit it with a copy of your current New Mexico driver's license or state identification card. Temporary ID’s are not accepted. You must provide documentation to support diagnosis of the medical condition, past treatments, potential health benefit vs. risk of Medical Cannabis and the date(s) of service.
NMSIIS Organization Security and Confidentiality Agreement 2023
Immunization - Form
January 3, 2023
Participant organization security and confidentiality agreement for the New Mexico Statewide Immunization Information System.
NMSIIS User Security and Confidentiality Agreement 2023
Immunization - Form
January 3, 2023
NMSIIS User Security and Confidentiality Agreement 2023
EMS Scope of Practice Addition or Deletion Suggestion Form
EMS Scope of Practice - Form
December 13, 2022
This form should be used for scope of practice addition or deletion suggestions.
Regional Office Request for Assistance
Regional Offices - Form
December 6, 2022
Regional Office Request for Assistance
Regional Office Request for Assistance Instructions for PDF form submissions
Mi Via Self-Directed Waiver Consultant Application Packet
Mi Via Self-Directed Waiver Consultant Enrollment - Form
December 1, 2022
Mi Via Self-Directed Waiver Consultant Application Packet
Mi Via Self-Directed Waiver Consultant Provider Agreement
Mi Via Self-Directed Waiver Consultant Enrollment - Form
December 1, 2022
Mi Via Self-Directed Waiver Consultant Provider Agreement
Developmental Disabilities (DD) Waiver Provider Application Forms
DD & Medically Fragile Waiver Provider Enrollment - Form
November 17, 2022
Developmental Disabilities (DD) Waiver Provider Application Forms
Supports Waiver (SW) Provider Application
DD & Medically Fragile Waiver Provider Enrollment - Form
November 17, 2022
Supports Waiver (SW) Provider Application
Supports Waiver (SW) Provider Application Forms
DD & Medically Fragile Waiver Provider Enrollment - Form
November 17, 2022
Supports Waiver (SW) Provider Application Forms
Developmental Disabilities (DD) Waiver Provider Application
DD & Medically Fragile Waiver Provider Enrollment - Form
November 17, 2022
DDW/MFW/SW Provider Application Packet
DDW/MFW/SW Renewing Provider Application Forms
DD & Medically Fragile Waiver Provider Enrollment - Form
November 17, 2022
DDW/MFW/SW Renewing Provider Application Forms
DDW/MFW/SW Provider Agreement Amendment Form
DD & Medically Fragile Waiver Provider Enrollment - Form
November 17, 2022
DDW/MFW/SW Provider Agreement Amendment Form
DDW/MFW/SW Self-Imposed Moratorium Form
DD & Medically Fragile Waiver Provider Enrollment - Form
November 17, 2022
DDW/MFW/SW Self-Imposed Moratorium Form
DDW/MFW/SW Provider Agreement Form
DD & Medically Fragile Waiver Provider Enrollment - Form
November 17, 2022
DDW/MFW/SW Provider Agreement Form
Special Skills Annual/Semi-Annual Form
EMS Scope of Practice - Form
November 9, 2022
Special Skills Annual/Semi-Annual Form