Forms
Family Roadmap
Children's Medical Services - Form
December 19, 2012
This form makes it easy for families to track their baby’s hearing screening follow-up tasks from birth to 6 months old.
Birth Record Search Application
Vital Records - Form
September 28, 2012
Use this form to request a birth certificate.
Death Record Search Application
Vital Records - Form
September 28, 2012
Use this form to request a death certificate.
EMS Agency Certification Application Form
EMS Agency Certification - Form
August 14, 2012
This form should be used by emergency medical rescue programs and emergency dispatch centers to apply for certification.
Putative Father Registry Search Inquiry
Vital Records - Form
July 2, 2012
A request for a search of the registry may only be made by a court of competent jurisdiction; a department authorized by law to take actions affecting a child’s health, safety or welfare; the petitioner’s attorney or the mother of the child.
EMS License Plate Order Form
Emergency Medical Systems - Form
July 2, 2012
This form should be used to order a special Emergency Medical Services license plate from the New Mexico Motor Vehicles Division.
EMS Agency Certification Emergency Medical Rescue Inspection Checklist
EMS Agency Certification - Form
April 17, 2012
This is a checklist for emergency medical rescue program certification.
Electronic Transfer of Biology Data Release Form
Biology - Form
February 22, 2012
Use this form to request the release of confidential patient information data.
Report of Adoption
Vital Records - Form
February 17, 2012
This form is required for each adoption decreed in the state of New Mexico.
Fort Bayard Dietary Interview Form
Fort Bayard Medical Center - Form
January 10, 2012
This dietary interview form is required for admission to Fort Bayard Medical Center.
EMS Agency Certification Emergency Medical Dispatch Center Inspection Checklist
EMS Agency Certification - Form
November 8, 2011
This is a checklist for emergency medical dispatch center certification.
Stroke Assessment Tool
EMS Stroke/STEMI - Form
August 2, 2011
Use this form to assess a patient who may have experienced a stroke.
Rabies Submission Form for Veterinarians
Zoonotic Diseases - Form
June 20, 2011
Veterinarians should use this form to submit specimens to the State Laboratory Division for testing.
HIV/AIDS Access Recertification Form
HIV Services Program - Form
May 24, 2011
Use this form to recertify for the HIV/AIDS access program.
EMS Complaint Form
Emergency Medical Systems - Form
June 8, 2010
This form may be used to submit a complaint regarding an Emergency Medical Technician, Emergency Medical Dispatcher, Emergency Medical Services (Ground & Air), Emergency Medical Systems training program, or Emergency Medical Services instructor.