Forms
CDC-Revised document as COVID-19 Vaccine Program Provider Agreement
CDC-Supplemental document as COVID-19 Vaccine Redistribution Agreement
User security and confidentiality agreement for the New Mexico Statewide Immunization Information System.
Participant organization security and confidentiality agreement for the New Mexico Statewide Immunization Information System.
This form is used by a patient/parent/legal guardian to remove records from the New Mexico Statewide Immunization Information System.
This form is used by a patient/parent/legal guardian to decline to participate in the New Mexico Statewide Immunization Information System.
This form allows you to provide immunization information for entry into NMSIIS.
This form may be used by adult patients aged 19 and older to provide vaccination consent to a healthcare provider.
Got Shots Fillable Form
Got Shots? Fillable Form - Eng
Got Shots? Fillable Form - Esp
This form should be used as Consent for COVID-19 Vaccinations
This form should be used as Consent for COVID-19 Vaccinations
This form should be used as Consent for COVID-19 Vaccinations
This form should be used to report out of range temperature incidents and submit a troubleshooting record to the vaccines for children program.
Colfax, Guadalupe, Harding, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Taos, and Union
Cibola, McKinley, San Juan, Sandoval, Torrance, and Valencia