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Photo of the publication cover. EMS Reciprocity Licensing Application (updated April 2020) EMS Licensing - Form April 22, 2020

This form should be used for reciprocity applicants.

Reciprocity Licensing Instructions



Photo of the publication cover. VaxViewNM Demographic and Contact Information Form Immunization - Form April 15, 2020

VaxViewNM Demographic and Contact Information Form



Photo of the publication cover. Certificate of Exemption from Immunization (English) Immunization - Form April 14, 2020

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 (Spanish) Immunization - Form April 14, 2020

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. Still Birth Record Search Application Vital Records - Form February 26, 2020

Use this form to request a still birth certificate.



Photo of the publication cover. Water Analysis Request Form Biology - Form February 19, 2020

Use this form to request water sample analysis.



Photo of the publication cover. VFC Transport Temperature Log Form for Refrigerated Vaccines Immunization - Form February 14, 2020

Complete this log when transporting vaccines to an alternate or back-up refrigerator, or when transferring to another provider.



Photo of the publication cover. Family Supports and Reimbursement Program Application State General Funded Services - Form January 29, 2020

This is the Family Supports and Reimbursement Program Application Form.



Photo of the publication cover. FIT Awareness Materials Order Form Family Infant Toddler Program - Form January 21, 2020

Family Infant Toddler Awareness Materials Order Form



Photo of the publication cover. Therapy Services QA Review Tool Clinical Services - Form January 10, 2020

Therapy Services QA Review Tool

Therapy Services QA Review Tool







Photo of the publication cover. EMS Initial Licensing Application EMS Licensing - Form November 25, 2019

This form should be used for initial applicants.

Initial Licensing Instructions



Photo of the publication cover. EMS Renewal Licensing Application EMS Licensing - Form November 25, 2019

This form should be used for renewal applicants.

Renewal Licensing Instructions



Photo of the publication cover. VFC Emergency Vaccine Management Plan Immunization - Form November 22, 2019

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.



Photo of the publication cover. VFC Routine Vaccine Management Plan Immunization - Form November 22, 2019

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.



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. 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.

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