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Photo of the publication cover. Request to Change Gender Designation on a Birth Certificate: Adult Form Vital Records - Form October 28, 2019

This form allows an adult to request a gender designation change on their own birth certificate.



Photo of the publication cover. Request to Change Gender Designation on a Birth Certificate: Parent/Legal Guardian Form Vital Records - Form October 28, 2019

This form allows the legal parent/guardian to request a gender designation change on their child's birth certificate.



Photo of the publication cover. Request to Change Gender Designation on a Birth Certificate: Two Parent Signature Form Vital Records - Form October 28, 2019

This form allows parents to request a gender designation change on their child's birth certificate.



Photo of the publication cover. Request to Change Gender Designation on a Birth Certificate: 14 Years of Age or Over Consent Form Vital Records - Form October 28, 2019

This additional form is required to request a gender change on a birth certificate if the registrant is 40 years of age or over.



Photo of the publication cover. Authorization to Disclose Health Information (English) Security Office - Form October 8, 2019

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.

Authorization to Disclose Health Information (Spanish)



Photo of the publication cover. Therapy Services: Discontinuation of Therapy Report (Template) Clinical Services - Form September 17, 2019

Therapy Services: Discontinuation of Therapy Report (Template)



Photo of the publication cover. Prefilled Specimen Submission Form for norovirus testing (raw stool) Norovirus - Form September 9, 2019

Prefilled Specimen Submission Form for norovirus testing (raw stool)



Photo of the publication cover. Prefilled Specimen Submission Form for enteric bacteria testing (transport media) Norovirus - Form September 9, 2019

Prefilled Specimen Submission Form for enteric bacteria testing (transport media)



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. 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. NM J-1 Waiver Application 2021 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. FIT Developmental Specialist Recertification Application Training - Form June 5, 2019

FIT Developmental Specialist Recertification Application



Photo of the publication cover. FIT Developmental Specialist Initial Certification Application Training - Form June 4, 2019

FIT Developmental Specialist Initial Certification Application



Photo of the publication cover. Inspection of Public Records Request Form Inspection of Public Records Act - Form May 30, 2019

Access to public records is one of the fundamental rights afforded people in a democracy. Even where there is no statute, a common law right to inspect and copy public records affords members of the public the opportunity to keep a watchful eye on government. In accordance with the Inspection of Public Records Act by the New Mexico Attorney General, you may use this form to submit a formal request to inspect public records.



Photo of the publication cover. Turquoise Lodge Adult Financial Eligibility Form Turquoise Lodge Hospital - Form May 10, 2019

This form should be completed to determine financial eligibility for adult patients.



Photo of the publication cover. Radio Frequency Interference Check - Intoxilyzer 8000 Breath Alcohol - Form April 23, 2019

Radio Frequency Interference Check - Intoxilyzer 8000



Photo of the publication cover. Community Program ANE Reporting Form Community Programs - Form April 5, 2019

Use this form to report Abuse, Neglect & Exploitation in community-based medicaid waiver programs.



Photo of the publication cover. Application for CMP Funds Health Improvement - Form April 5, 2019

Application for CMP Funds

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