Forms

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.

Public Health Emergency Licensing Instruction

Public Health Emergency Licensing Instructions

NMDOH Visitor Screening Tool

NMDOH Herramienta de Detección de Visitantes

Use this form to request a still birth certificate.

Use this form to request water sample analysis.

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

This is the Family Supports and Reimbursement Program Application Form.

Therapy Services QA Review Tool

Therapy Services QA Review Tool

Mi Via Self-Directed Waiver: Consultant Services Monthly Update Form

Mi Via Self-Directed Waiver: Consultant Services Monthly Update Form (printable)

Mi Via Self-Directed Waiver: Consultant Services Quarterly Update Form

Mi Via Self-Directed Waiver: Consultant Services Quarterly Update Form (printable)

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.

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.

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

Use this form to provide consent for mirena intrauterine device.

Consentimiento de Levonorgestrel Dispositivo Intrauterino

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

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

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

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

Use this form to provide consent for paragard intrauterine device.

Consentimiento de Paragard Dispositivo Intrauterino

Use this form to provide consent for implanon nexplanon.

Consentimiento de Implante Anticonceptivo