Forms
Use this form to file a complaint against a midwife.
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 should be used as Consent for COVID-19 Vaccinations
SLD General Clinical Request Form v. 4.1
This form should be used to report out of range temperature incidents and submit a troubleshooting record to the vaccines for children program.
Credentialing COVID-19 Providers Form
EMS Local Funding Program Application Form
EMS Local Funding Program Annual Service Report Form
This form should be used to apply for the local funding grant program.
This form should be used to report annual service for the local funding grant program.
MCP New Laboratory Application.
DDW Case Management:HP_10.14.2020
This document describes the required process for eligible trauma system development projects to receive funding. Funding will be issued through a separate agreement between each approved organization and the New Mexico Department of Health Memorandum of Agreement process.
COVID Test Request Form Prefilled
DDW Case Management: OR Budget Worksheet for Adults Sample
Regional Office Request for Assistance