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Photo of the publication cover. Midwifery Advisory Board application Certified Nurse Midwives and Licensed Midwives - Form September 21, 2022

Midwifery Advisory Board application



Photo of the publication cover. COVID-19 Vaccine Troubleshooting Report Immunization - Form August 24, 2022

COVID-19 Vaccine Troubleshooting Report



Photo of the publication cover. NM J-1 Waiver Application 2023 Primary Care & Rural Health - Form August 17, 2022

The New Mexico J-1 waiver program allows foreign medical graduates to obtain a waiver of their 2 year foreign residence requirement in exchange for a commitment to practice in underserved areas of New Mexico after the completion of their training.



Photo of the publication cover. VFC School Immunization Consent Form Immunization - Form August 17, 2022

This is the form to be completed by parents or guardians indicating whether or not a child is to be vaccinated at school.

VFC School Immunization Consent Form (Spanish)



Photo of the publication cover. VFC Vaccine Administration Form (Part B) Immunization - Form August 17, 2022

This form allows you to provide immunization information for entry into NMSIIS.

VFC Vacuna Forma Administración (Parte B)



Photo of the publication cover. Hepatitis B Immune Globulin (HBIG) Reporting Form Perinatal Hepatitis B Prevention - Form August 9, 2022

Please complete this information on every newborn receiving hepatitis B immune globulin (HBIG).



Photo of the publication cover. NMHSC Stipend Applicant Reference Report for 2022 Primary Care & Rural Health - Form May 19, 2022

The New Mexico Health Service Corps provides stipends to eligible health professionals during their last two years of training or residency who, in turn, enter into contract with the Department of Health to provide (when licensed) health service for a minimum of two years (1600 hours per year) in an underserved area of New Mexico. This document lists a person who is not a relative and who is in a position to comment on the applicant’s academic and/or professional ability.



Photo of the publication cover. CDC-Revised document as COVID-19 Vaccine Program Provider Agreement Immunization - Form May 18, 2022

CDC-Revised document as COVID-19 Vaccine Program Provider Agreement



Photo of the publication cover. CDC-Supplemental document as COVID-19 Vaccine Redistribution Agreement Immunization - Form May 18, 2022

CDC-Supplemental document as COVID-19 Vaccine Redistribution Agreement



Photo of the publication cover. Turquoise Lodge Authorization to Disclose Health Information Form Turquoise Lodge Hospital - Form May 18, 2022

This form should be used to authorize the disclosure of health information for patients.



Photo of the publication cover. Therap Caseload Tool (How-To Check, Add, and Remove Individuals) Clinical Services - Form April 27, 2022

Therap Caseload Tool (How-To Check, Add, and Remove Individuals)



Photo of the publication cover. Assignment of Benefits and Consent Form Family Planning - Form April 14, 2022

Assignment of Benefits and Consent Form





Photo of the publication cover. Mi Via Self-Directed Waiver Consultant Application Packet Mi Via Self-Directed Waiver Consultant Enrollment - Form March 7, 2022

Mi Via Self-Directed Waiver Consultant Application Packet



Photo of the publication cover. Medical Cannabis Caregiver Application Medical CannabisEducational Materials, Resources, Publications and Archives - Form February 23, 2022

To enroll as a personal caregiver for an existing medical cannabis patient(s), you must complete this application and submit it with a copy of your New Mexico driver's license or state identification card and background check.



Photo of the publication cover. Medical Cannabis Patient Application Medical CannabisEducational Materials, Resources, Publications and Archives - Form February 23, 2022

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.





Photo of the publication cover. NMDOH Internship Application Performance Management System - Form February 18, 2022

NMDOH Internship Application



Photo of the publication cover. Employee Abuse Registry Removal Petition Employee Abuse Registry - Form February 17, 2022

After a period of three years from the effective date of placement on the registry, an individual on the registry may petition for removal from the registry. The petition shall be sent to the custodian of the registry.



Photo of the publication cover. Sliding Fee Scale Family Planning - Form February 8, 2022

Sliding Fee Scale

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