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Photo of the publication cover. Adult Vaccine Consent Form Immunization - Form September 9, 2019

This form may be used by adult patients aged 19 and older to provide vaccination consent to a healthcare provider.

Adultos Vacuna Formulario de Consentimiento



Photo of the publication cover. VFC Vaccine Administration Form (Part B) Immunization - Form September 9, 2019

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

VFC Vacuna Forma Administración (Parte B)



Photo of the publication cover. VFC School Immunization Consent Form Immunization - Form August 29, 2019

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. VaxViewNM Demographic and Contact Information Form Immunization - Form August 19, 2019

VaxViewNM Demographic and Contact Information Form



Photo of the publication cover. Certificate of Exemption from Immunization (ES) Immunization - Form July 30, 2019

This form may be used by individuals requesting a religious or medical exemption to immunization for their children whom attend any public, private or parochial pre-school, kindergarten, elementary, secondary school, or home school and for children attending daycare of childcare facilities.



Photo of the publication cover. Certificate of Exemption from Immunization Immunization - Form July 25, 2019

This form may be used by individuals requesting a religious or medical exemption to immunization for their children whom attend any public, private or parochial pre-school, kindergarten, elementary, secondary school, or home school and for children attending daycare of childcare facilities.

Certificate of Exemption FAQ



Photo of the publication cover. VFC Transport Temperature Log Form for Refrigerated Vaccines Immunization - Form February 8, 2019

Complete this log when transporting vaccines to an alternate or back-up refrigerator, or when transferring to another provider.



Photo of the publication cover. NMSIIS Decision to Remove Record Immunization - Form February 6, 2019

This form is used by a patient/parent/legal guardian to remove records from the New Mexico Statewide Immunization Information System.



Photo of the publication cover. NMSIIS Decline to Participate Form Immunization - Form February 6, 2019

This form is used by a patient/parent/legal guardian to decline to participate in the New Mexico Statewide Immunization Information System.



Photo of the publication cover. NMSIIS User Security and Confidentiality Agreement Immunization - Form January 2, 2019

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



Photo of the publication cover. NMSIIS Participant Organization Security and Confidentiality Agreement Immunization - Form January 2, 2019

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