New Mexico Department of Health
Our mission is to promote health and wellness, improve health outcomes, and assure safety net services for all people in New Mexico.
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Forms

Photo of the publication cover. Community Health Worker State Certification Renewal Application Community Health Workers - Form July 18, 2017

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



Photo of the publication cover. JOE Instructor Coordinator Renewal Application EMS Committees - Form July 14, 2017

This is the renewal application for existing instructor/coordinators.



Photo of the publication cover. JOE Instructor Coordinator Initial Application EMS Committees - Form July 14, 2017

This is the initial application for new instructor/coordinators.



Photo of the publication cover. JOE Instructor Coordinator Re-Entry Application EMS Committees - Form July 14, 2017

This is the re-entry application for instructor/coordinators.



Photo of the publication cover. EMS Award Nomination Form Emergency Medical Systems - Form July 11, 2017

The EMS Bureau is pleased to announce the call for 2017 EMS Award Nominations. All members of the EMS Community are urged to consider potential candidates. Please review the following categories and submit your nominations for consideration. This is your chance to recognize someone outstanding in your agency and profession. Any individual may submit nominations.



Photo of the publication cover. Harm Reduction and Hepatitis Monthly Report Cover Sheet Harm Reduction - Form July 5, 2017

This is the monthly report cover sheet for the harm reduction and hepatitis program.



Photo of the publication cover. Naloxone Inventory and Order Form Harm Reduction - Form July 5, 2017

Use this form to manage inventory and orders of naloxone.



Photo of the publication cover. Naloxone Enrollment and Record of Use Form Harm Reduction - Form July 5, 2017

Use this form to enroll and record use of naloxone.



Photo of the publication cover. Syringe Service Enrollment and Daily Log Form Combined Harm Reduction - Form July 5, 2017

Combined syringe service enrollment and daily log forms.



Photo of the publication cover. Chemistry Analysis Request Form Chemistry - Form June 29, 2017

Use this form to request general chemistry analysis.

Instructions
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Photo of the publication cover. EMS Request for Replacement Licensure Card EMS Licensing - Form June 20, 2017

This is the form to be used for requesting a replacement licensure card.



Photo of the publication cover. Certificate of Exemption from Immunization Immunization - Form June 20, 2017

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. EMS Initial Licensing Application EMS Licensing - Form June 9, 2017

This form should be used for initial applicants.

Initial Licensing Instructions



Photo of the publication cover. EMS Renewal Licensing Application EMS Licensing - Form June 9, 2017

This form should be used for renewal applicants.

Renewal Licensing Instructions



Photo of the publication cover. EMS Re-Entry Licensing Application EMS Licensing - Form June 9, 2017

This form should be used for re-entry applicants.

Re-Entry Licensing Instructions



Photo of the publication cover. EMS Reciprocity Licensing Application EMS Licensing - Form June 9, 2017

This form should be used for reciprocity applicants.

Reciprocity Licensing Instructions



Photo of the publication cover. Community Health Worker Continuing Education Unit Provider Application Community Health Workers - Form June 8, 2017

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



Photo of the publication cover. Community Health Worker Certification through Grandfathering Application Community Health Workers - Form June 8, 2017

This is the application detailing required documentation, eligibility requirements, and submission guidelines for Community Health Worker Certification through Grandfathering.

Certificación de los Trabajadores de Salud Comunitarios a Través de Derechos Adquiridos



Photo of the publication cover. Community Health Worker Certification General Application Community Health Workers - Form June 8, 2017

This is the general certification application for community health workers who are not eligible grandfathering.



Photo of the publication cover. JOE Education Designee Form EMS Committees - Form May 19, 2017

This form is applicable for the following entities to utilize: the director and medical director of the academy, and the director and medical director of each approved emergency medical services training program, the state emergency medical services medical director, and the bureau chief whose designee shall serve without vote.

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