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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. DDW Case Management Monthly Site Visit Form Developmental Disabilities Waiver - Form June 27, 2019

This is the fillable form reference tool for THERAP.



Photo of the publication cover. Admission Application for New Mexico State Veterans' Home Veterans' Home - Form June 26, 2019

Fill out this application to apply for admission to the New Mexico State Veterans' Home.





Photo of the publication cover. New Mexico J-1 Waiver Application 2020 Primary Care & Rural Health - Form June 25, 2019

The New Mexico J-1 waiver program allows foreign medical graduates to obtain a waiver of their 2 year foreign residence requirement in exchange for a commitment to practice in underserved areas of New Mexico after the completion of their training.

Attachment A
Attachment C



Photo of the publication cover. Clinical Test Request Form Biology - Form June 21, 2019

Use this form to request general biological clinical analysis.

Clinical Test Request Form (Pre-Populated for Zika Virus)



Photo of the publication cover. Medical Cannabis Personal Production Application Medical Cannabis Program - Form June 14, 2019

Qualified Patients with current valid enrollment who want to produce medical cannabis for themselves may complete the Personal Production Application and submit it with a copy of your New Mexico driver's license or state identification card and the license fee.



Photo of the publication cover. Medical Cannabis Caregiver Application Medical Cannabis Program - Form June 14, 2019

To enroll as a personal caregiver for an existing medical cannabis patient(s), you must complete this application and submit it with a copy of your New Mexico driver's license or state identification card and background check.



Photo of the publication cover. Medical Cannabis Patient Application Medical Cannabis Program - Form June 14, 2019

The application for first time and returning patients is the same. Please complete this form and submit it with a copy of your current New Mexico driver's license or state identification card. Temporary ID’s are not accepted. You must provide documentation to support diagnosis of the medical condition, past treatments, potential health benefit vs. risk of Medical Cannabis and the date(s) of service.



Photo of the publication cover. Medical Cannabis Patient Info Change or Card Replacement Medical Cannabis Program - Form June 10, 2019

If your personal information has changed, you have moved, new phone number, stopped using Medical Cannabis, you have lost or damaged your card, you must complete this form and submit it with your current Patient ID Card and/or Personal Production License Card and a copy of your New Mexico driver's license or state identification card.



Photo of the publication cover. FIT Developmental Specialist Recertification Application Family Infant Toddler Training - Form June 5, 2019

FIT Developmental Specialist Recertification Application



Photo of the publication cover. FIT Developmental Specialist Initial Certification Application Family Infant Toddler Training - Form June 4, 2019

FIT Developmental Specialist Initial Certification Application



Photo of the publication cover. Transition to Employment Program Application Community Inclusion - Form June 3, 2019

Transition to Employment Application



Photo of the publication cover. Inspection of Public Records Request Form Inspection of Public Records - Form May 30, 2019

Access to public records is one of the fundamental rights afforded people in a democracy. Even where there is no statute, a common law right to inspect and copy public records affords members of the public the opportunity to keep a watchful eye on government. In accordance with the Inspection of Public Records Act by the New Mexico Attorney General, you may use this form to submit a formal request to inspect public records.



Photo of the publication cover. Turquoise Lodge Authorization to Disclose Health Information Form Turquoise Lodge Hospital - Form May 10, 2019

This form should be used to authorize the disclosure of health information for patients.



Photo of the publication cover. Turquoise Lodge Adult Financial Eligibility Form Turquoise Lodge Hospital - Form May 10, 2019

This form should be completed to determine financial eligibility for adult patients.



Photo of the publication cover. EMS Initial Licensing Application EMS Licensing - Form April 30, 2019

This form should be used for initial applicants.

Initial Licensing Instructions



Photo of the publication cover. Radio Frequency Interference Check - Intoxilyzer 8000 Breath Alcohol - Form April 23, 2019

Radio Frequency Interference Check - Intoxilyzer 8000



Photo of the publication cover. Community Program ANE Reporting Form Community Programs - Form April 5, 2019

Use this form to report Abuse, Neglect & Exploitation in community-based medicaid waiver programs.

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