Forms
VFC Northeast Region Temperature Log Form
Immunization - Form
November 14, 2024
Colfax, Guadalupe, Harding, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Taos, and Union
VFC Northwest Region Temperature Log Form
Immunization - Form
November 14, 2024
Cibola, McKinley, San Juan, Sandoval, Torrance, and Valencia
VFC Southeast (A) Region Temperature Log Form
Immunization - Form
November 14, 2024
Chaves, Curry, DeBaca, Lincoln, and Quay
VFC Southeast (B) Region Temperature Log Form
Immunization - Form
November 14, 2024
Eddy, Lea, Lincoln, and Roosevelt
VFC Southwest Region Temperature Log Form
Immunization - Form
November 14, 2024
Catron, Dona Ana, Grant, Hidalgo, Luna, Otero, Sierra, and Socorro
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.