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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



Photo of the publication cover. Medical Cannabis Patient Info Change or Card Replacement Medical CannabisEducational Materials, Resources, Publications and Archives - Form February 8, 2022

If your personal information has changed, you have moved, new phone number, stopped using Medical Cannabis, you have lost or damaged your card, you must complete this form and submit it with your current Patient ID Card and/or Personal Production License Card and a copy of your New Mexico driver's license or state identification card.





Photo of the publication cover. NMSIIS User Security and Confidentiality Agreement Immunization - Form January 26, 2022

User security and confidentiality agreement for the New Mexico Statewide Immunization Information System.



Photo of the publication cover. Electronic Certifier Training Request Form Vital Records - Form January 21, 2022

Electronic Certifier Training Request Form



Photo of the publication cover. Compliant Reporting Poster 2022 Health Improvement - Form January 13, 2022

Compliant Reporting Poster 2022



Photo of the publication cover. OCHW Registration Form - Deadline Feb 4, 2022 Community Health Workers - Form January 12, 2022

OCHW Registration Form - Deadline Feb 4, 2022

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