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. Immunization Assessment Worksheet for 7th Grade Immunization - Form September 8, 2017

Immunization Assessment Worksheet for 7th Grade



Photo of the publication cover. Immunization Assessment Worksheet for Kindergarten Immunization - Form September 8, 2017

Immunization Assessment Worksheet for Kindergarten



Photo of the publication cover. VFC Northeast Region Temperature Log Form Immunization - Form August 30, 2017

Counties: Colfax, Guadalupe, Harding, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Taos, and Union



Photo of the publication cover. JOE Instructor Coordinator Transfer Request EMS Committees - Form August 15, 2017

This is a document to be filled out when an Instructor Coordinator is changing his/her training institution affiliation or adding an affiliation with a training institution.



Photo of the publication cover. EMS Reciprocity Licensing Application EMS Licensing - Form August 15, 2017

This form should be used for reciprocity applicants.

Reciprocity Licensing Instructions



Photo of the publication cover. EMS Re-Entry Licensing Application EMS Licensing - Form August 15, 2017

This form should be used for re-entry applicants.

Re-Entry Licensing Instructions



Photo of the publication cover. EMS Renewal Licensing Application EMS Licensing - Form August 15, 2017

This form should be used for renewal applicants.

Renewal Licensing Instructions



Photo of the publication cover. EMS Initial Licensing Application EMS Licensing - Form August 15, 2017

This form should be used for initial applicants.

Initial Licensing Instructions



Photo of the publication cover. EMS Fund Act FY19 Special Projects Vehicle Purchase Application EMS Fund Act - Form August 9, 2017 - November 18, 2017

Contact your regional office to obtain application approval to ensure it is complete. It is not the regions responsibility to send these applications to the bureau, unless they are complete.

EMS Fund Act FY19 Special Projects Vehicle Purchase Guide



Photo of the publication cover. EMS Fund Act FY19 Special Projects Statewide System Improvement Application EMS Fund Act - Form August 9, 2017 - November 18, 2017

Contact your regional office to obtain application approval to ensure it is complete. It is not the regions responsibility to send these applications to the bureau, unless they are complete.

EMS Fund Act FY19 Special Projects Statewide System Improvement Guide



Photo of the publication cover. EMS Fund Act FY19 Special Projects Local System Improvement Application EMS Fund Act - Form August 9, 2017 - November 18, 2017

Contact your regional office to obtain application approval to ensure it is complete. It is not the regions responsibility to send these applications to the bureau, unless they are complete.

EMS Fund Act FY19 Special Projects Local System Improvement Guide



Photo of the publication cover. Community Health Worker State Certification Renewal Application Community Health Workers - Form August 1, 2017

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. Turquoise Lodge Adolescent Authorization to Disclose Health Information Form Turquoise Lodge Hospital - Form August 1, 2017

This form should be used to authorize the disclosure of health information for adolescent patients.





Photo of the publication cover. Overdose Prevention and Education and Syringe Service Program Registration Form Harm Reduction - Form July 26, 2017

Use this form to register for the overdose prevention and education and syringe exchange program.



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. 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.

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