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This authorization allows the Department of Health (DOH) to disclose confidential health information about you. The authorization may be revoked. It will remain in effect for six (6) months unless a different time is stated. You are entitled to a copy of the completed authorization. There may be fees charged for any copying associated with this request. If you are a person with a disability and you require this authorization in an alternative format or require a special accommodation to complete this form, you may request assistance from staff at any DOH location or from the DOH Chief Privacy Officer.
The New Mexico Department of Health is required by law to keep your health information private and to tell you our legal duties and privacy practices. This document explains what kinds of information we collect, what we do with the information, who else can see your information, what your rights are, how to register a complaint, and more.