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Photo of the publication cover. VaxViewNM Demographic and Contact Information Form Immunization - Form August 19, 2019

VaxViewNM Demographic and Contact Information Form



Photo of the publication cover. EMS Fund Act FY21 Special Projects Local System Improvement Application EMS Fund Act - Form August 19, 2019 - August 19, 2020

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 FY21 Special Projects Local System Improvement Guide



Photo of the publication cover. EMS Fund Act FY21 Special Projects Statewide System Improvement Application EMS Fund Act - Form August 19, 2019 - August 19, 2020

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 FY21 Special Projects Statewide System Improvement Guide



Photo of the publication cover. EMS Fund Act FY21 Special Projects Vehicle Purchase Application EMS Fund Act - Form August 19, 2019 - August 19, 2020

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 FY21 Special Projects Vehicle Purchase Guide
EMS Fund Act Vehicle List Form



Photo of the publication cover. Prefilled Specimen Submission Form for GI Outbreaks Norovirus - Form August 12, 2019

Note: submission requires pre-approval from an on call epidemiologist at 505-827-0006



Photo of the publication cover. ACQ Authorization Form for Appointment Advisory Council on Quality - Form August 8, 2019

ACQ Authorization Form for Appointments



Photo of the publication cover. ACQ Application Questionnaire Advisory Council on Quality - Form August 8, 2019

ACQ Application Questionnaire (8/2019)



Photo of the publication cover. Hepatitis B Immune Globulin (HBIG) Reporting Form Perinatal Hepatitis B Prevention - Form August 5, 2019

Please complete this information on every newborn receiving hepatitis B immune globulin (HBIG).



Photo of the publication cover. DDW/MFW Renewing Provider Application Forms DD & Medically Fragile Waiver Provider Enrollment - Form August 2, 2019

DDW/MFW Renewing Provider Application Forms





Photo of the publication cover. Certificate of Exemption from Immunization (ES) Immunization - Form July 30, 2019

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. Certificate of Exemption from Immunization Immunization - Form July 25, 2019

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 FAQ



Photo of the publication cover. DDW Case Management Monthly Site Visit Form Developmental Disabilities Waiver - Form June 27, 2019

This is the fillable form reference tool for THERAP.



Photo of the publication cover. Admission Application for New Mexico State Veterans' Home Veterans' Home - Form June 26, 2019

Fill out this application to apply for admission to the New Mexico State Veterans' Home.





Photo of the publication cover. New Mexico J-1 Waiver Application 2020 Primary Care & Rural Health - Form June 25, 2019

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. Clinical Test Request Form Biology - Form June 21, 2019

Use this form to request general biological clinical analysis.

Clinical Test Request Form (Pre-Populated for Zika Virus)



Photo of the publication cover. Medical Cannabis Personal Production Application Medical Cannabis Program - Form June 14, 2019

Qualified Patients with current valid enrollment who want to produce medical cannabis for themselves may complete the Personal Production Application and submit it with a copy of your New Mexico driver's license or state identification card and the license fee.



Photo of the publication cover. Medical Cannabis Caregiver Application Medical Cannabis Program - Form June 14, 2019

To enroll as a personal caregiver for an existing medical cannabis patient(s), you must complete this application and submit it with a copy of your New Mexico driver's license or state identification card and background check.



Photo of the publication cover. Medical Cannabis Patient Application Medical Cannabis Program - Form June 14, 2019

The application for first time and returning patients is the same. Please complete this form and submit it with a copy of your current New Mexico driver's license or state identification card. Temporary ID’s are not accepted. You must provide documentation to support diagnosis of the medical condition, past treatments, potential health benefit vs. risk of Medical Cannabis and the date(s) of service.

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