Forms
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
Chaves, Curry, DeBaca, Lincoln, and Quay
Eddy, Lea, Lincoln, and Roosevelt
Catron, Dona Ana, Grant, Hidalgo, Luna, Otero, Sierra, and Socorro
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.
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.
Complete this log when transporting vaccines to an alternate or back-up refrigerator, or when transferring to another provider.
The New Mexico VFC Program requires each practice to develop and maintain an Emergency Vaccine Management Plan. Properly completing this template will meet the VFC Program requirement to have a written plan for storage and handling procedures in an emergency.
The New Mexico VFC Program requires each practice to develop and maintain a Routine Vaccine Management Plan. Properly completing this template will meet the VFC Program requirement for VFC Program participants to have written vaccine storage and handling plans.
This is a customizable form for use by schools to collect consent from parents so students' historic immunization records may be added to NMSIIS.
This form is to be used for needles/syringes, and e-kit medications and is for Vaccines for Children Approved Sites Only.
This is the letter addressed to parents or legal guardians to determine whether or not a child is to be vaccinated at school. This letter is to be sent out with the VFC school immunization consent form.
VFC Middle School Vaccination Letter/Permission Form (Spanish)
This document is for providers: guidelines and important dates for the transition to digital data loggers.
Healthcare providers may use this form to order adult vaccines.