Forms
VFC Transport Temperature Log Form for Refrigerated Vaccines
Immunization - Form
September 26, 2024
Complete this log when transporting vaccines to an alternate or back-up refrigerator, or when transferring to another provider.
NMSIIS Decision to Remove Record
Immunization - Form
June 14, 2024
This form is used by a patient/parent/legal guardian to remove records from the New Mexico Statewide Immunization Information System.
NMSIIS Organization Security and Confidentiality Agreement 2024
Immunization - Form
June 5, 2024
Participant organization security and confidentiality agreement for the New Mexico Statewide Immunization Information System.
NMSIIS User Security and Confidentiality Agreement 2024
Immunization - Form
June 5, 2024
NMSIIS User Security and Confidentiality Agreement 2024
Certificate of Exemption from Immunization (English)
Immunization - Form
June 5, 2024
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 from Immunization (Spanish)
Immunization - Form
June 5, 2024
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.
NMSIIS Decline to Participate Form
Immunization - Form
June 3, 2024
This form is used by a patient/parent/legal guardian to decline to participate in the New Mexico Statewide Immunization Information System.