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Photo of the publication cover. Sterilization – Protocol and Review Form Family Planning - Form October 3, 2023

Sterilization – Protocol and Review Form



Photo of the publication cover. The Uniform Health Care Decisions Act Surrogate Healthcare Decision Form Clinical Services - Form August 28, 2023

General information regarding capacity and the designation of a surrogate healthcare decision maker.



Photo of the publication cover. Medically Fragile Waiver Registration Form Medically Fragile Waiver - Form August 18, 2023

Medically Fragile Waiver Registration Form



Photo of the publication cover. Adult TSR Form Immunization - Form August 11, 2023

Adult TSR Form



Photo of the publication cover. NMHSC Stipend Program Guidelines for 2023 Primary Care & Rural Health - Form August 4, 2023

NMHSC Stipend Program Guidelines for 2023



Photo of the publication cover. 1915c Waivers Individual Transition Plan Checklist Developmental Disabilities Waiver - Form August 3, 2023

1915c Waivers Individual Transition Plan Checklist



Photo of the publication cover. NM J-1 Waiver Application 2024 Primary Care & Rural Health - Form August 2, 2023

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. EOL1 – Medical Aid in Dying Reporting Form Vital Records - Form August 2, 2023

EOL1 – Medical Aid in Dying Reporting Form



Photo of the publication cover. DD Waiver (HCBS) Application (Spanish) Eligibility Determination - Form August 1, 2023

DD Waiver (HCBS) Application (Spanish)



Photo of the publication cover. DD Waiver (HCBS) Application Eligibility Determination - Form July 31, 2023

DD Waiver (HCBS) Application



Photo of the publication cover. NMHSC Stipend Application for 2023 Primary Care & Rural Health - Form July 17, 2023

The New Mexico Health Service Corps provides stipends to eligible health professionals during their last two years of training or residency who, in turn, enter into contract with the Department of Health to provide (when licensed) health service for a minimum of two years (1600 hours per year) in an underserved area of New Mexico. This document is the application for this program.



Photo of the publication cover. NMHSC Stipend Applicant Reference Report for 2023 Primary Care & Rural Health - Form July 3, 2023

NMHSC Stipend Applicant Reference Report for 2023



Photo of the publication cover. HIV/AIDS Confidential Case Reporting Form HIV Surveillance & Epidemiology - Form June 27, 2023

Use this form to confidentially report a case of HIV/AIDS.



Photo of the publication cover. CNA Reciprocity Form Program Operations - Form June 21, 2023

CNA Reciprocity Form



Photo of the publication cover. Community Health Worker Continuing Education Unit Provider Application Community Health Workers - Form June 21, 2023

This is the application to become an approved Continuing Education Unit Provider.



Photo of the publication cover. Community Health Worker State Certification Renewal Application Community Health Workers - Form June 21, 2023

This is the application detailing required documentation, eligibility requirements, and submission guidelines for Community Health Worker state certification renewal.

Solicitud de Renovación de Certificación Estatal de Trabajadores de Salud Comunitarios



Photo of the publication cover. IR-8000 Operator Training Request Form Breath Alcohol - Form June 14, 2023

Use this form to request test operator training.



Photo of the publication cover. IR-8000 Key Operator Training Request Form Breath Alcohol - Form June 14, 2023

Use this form to request key operator training.



Photo of the publication cover. Breath Alcohol Training Cancellation Notification Form Breath Alcohol - Form June 14, 2023

Use this form to cancel training requests.



Photo of the publication cover. VFC Provider Staff Change of Contact and uploading Training Immunization - Form April 13, 2023

VFC Provider Staff Change of Contact and uploading Training

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