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Photo of the publication cover. Medical Cannabis Manufacturer Application Medical Cannabis Producers & Distributors - Form November 20, 2019

This is the application for those interested in manufacturing medical cannabis products.



Photo of the publication cover. Affidavit of Review of a Certified New Mexico Birth Certificate Vital Records - Form November 20, 2019

This form is to be used by agencies and organizations to document eligibility. This should not be accepted in place of a birth certificate.



Photo of the publication cover. Certificate of Exemption from Immunization Immunization - Form November 20, 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. Certificate of Exemption from Immunization (ES) Immunization - Form November 20, 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. EMS Information Update and License Replacement Form EMS Licensing - Form November 12, 2019

This is the form to be used for requesting a replacement licensure card.





Photo of the publication cover. EMS Local Funding Program Application Form EMS Fund Act - Form November 5, 2019 - January 24, 2020

This form should be used to apply for the local funding grant program.



Photo of the publication cover. EMS Local Funding Program Annual Service Report Form EMS Fund Act - Form November 5, 2019 - January 24, 2020

This form should be used to report annual service for the local funding grant program.



Photo of the publication cover. Request to Change Gender Designation on a Birth Certificate: Adult Form Vital Records - Form October 28, 2019

This form allows an adult to request a gender designation change on their own birth certificate.



Photo of the publication cover. Request to Change Gender Designation on a Birth Certificate: Parent/Legal Guardian Form Vital Records - Form October 28, 2019

This form allows the legal parent/guardian to request a gender designation change on their child's birth certificate.



Photo of the publication cover. Request to Change Gender Designation on a Birth Certificate: Two Parent Signature Form Vital Records - Form October 28, 2019

This form allows parents to request a gender designation change on their child's birth certificate.



Photo of the publication cover. Request to Change Gender Designation on a Birth Certificate: 14 Years of Age or Over Consent Form Vital Records - Form October 28, 2019

This additional form is required to request a gender change on a birth certificate if the registrant is 40 years of age or over.



Photo of the publication cover. VFC Troubleshooting Record Form Immunization - Form October 19, 2019

This form should be used to report out of range temperature incidents and submit a troubleshooting record to the vaccines for children program.



Photo of the publication cover. Family Planning Paragard Intrauterine Device Consent Form Family Planning - Form October 15, 2019

Use this form to provide consent for paragard intrauterine device.

Consentimiento de Paragard Dispositivo Intrauterino



Photo of the publication cover. Family Planning Contraceptive Implant Consent Form Family Planning - Form October 15, 2019

Use this form to provide consent for implanon nexplanon.

Consentimiento de Implante Anticonceptivo



Photo of the publication cover. Authorization to Disclose Health Information (English) Security Office - Form October 8, 2019

This authorization allows the Department of Health (DOH) to disclose confidential health information about you. The authorization may be revoked. It will remain in effect for six (6) months unless a different time is stated. You are entitled to a copy of the completed authorization. There may be fees charged for any copying associated with this request. If you are a person with a disability and you require this authorization in an alternative format or require a special accommodation to complete this form, you may request assistance from staff at any DOH location or from the DOH Chief Privacy Officer.

Authorization to Disclose Health Information (Spanish)



Photo of the publication cover. New Mexico Nurse Aide Training and Registry Reciprocity Form Program Operations - Form September 26, 2019

New Mexico Nurse Aide Training and Registry Reciprocity Form



Photo of the publication cover. STD Case Reporting Form Sexually Transmitted Diseases - Form September 25, 2019

All STD cases diagnosed or treated in New Mexico are required by law to be reported to the STD Program in Santa Fe. Additionally, any medical laboratory anywhere in the United States performing testing for New Mexico must report positive results to the New Mexico STD Program in Santa Fe.



Photo of the publication cover. Therapy Services: Discontinuation of Therapy Report (Template) Clinical Services - Form September 17, 2019

Therapy Services: Discontinuation of Therapy Report (Template)



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

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