Forms
Certificate of Exemption from Immunization (English)
Immunization - Form
February 19, 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.
Acknowledgement for HCBS Consumer Rights and Freedoms
Supports Waiver - Form
February 7, 2024
Acknowledgement for HCBS Consumer Rights and Freedoms
DFA Agency Certification Form
Breast and Cervical Cancer - Form
February 2, 2024
DFA Agency Certification Form
FY24 Clinic Based Patient Navigation Form (Print Version)
Breast and Cervical Cancer - Form
February 2, 2024
FY24 Clinic Based Patient Navigation Form (Print Version)
FY24 Clinic Based Patient Navigation Form (PDF Fillable Version)
New Provider Application
Breast and Cervical Cancer - Form
February 2, 2024
BCC Program New Provider Application Documents - New Provider Application
Provider Contact Form
Breast and Cervical Cancer - Form
February 2, 2024
BCC Program New Provider Application Documents - Provider Contact Form
Provider Credential List
Breast and Cervical Cancer - Form
February 2, 2024
BCC Program New Provider Application Documents - Provider Credential List
Substitute W-9
Breast and Cervical Cancer - Form
February 2, 2024
BCC Program New Provider Application Documents - Substitute W-9
Campaign Contribution Disclosure Form
Breast and Cervical Cancer - Form
February 2, 2024
BCC Program New Provider Application Documents - Campaign Contribution Disclosure Form
FY24 Eligibility and Consent Form (English)
Breast and Cervical Cancer - Form
February 2, 2024
FY24 Eligibility and Consent Form (English)
FY24 Eligibility and Consent Form (Spanish)
FY24 Screening and Referral Form (Print Version)
Labware Client Access Request Form
Labware Clinical Client Portal - Form
January 22, 2024
Request form for existing Biological Sciences Bureau Clinical and Epidemiological Submitters.
Affidavit of Review of a Certified New Mexico Birth Certificate
Vital Records - Form
January 10, 2024
This form is to be used by agencies and organizations to document eligibility. This should not be accepted in place of a birth certificate.
NMSIIS Decision to Remove Record
Immunization - Form
January 10, 2024
This form is used by a patient/parent/legal guardian to remove records from the New Mexico Statewide Immunization Information System.
NMSIIS Decline to Participate Form
Immunization - Form
January 10, 2024
This form is used by a patient/parent/legal guardian to decline to participate in the New Mexico Statewide Immunization Information System.
NMSIIS Organization Security and Confidentiality Agreement 2024
Immunization - Form
December 29, 2023
Participant organization security and confidentiality agreement for the New Mexico Statewide Immunization Information System.
NMSIIS User Security and Confidentiality Agreement 2024
Immunization - Form
December 29, 2023
NMSIIS User Security and Confidentiality Agreement 2024
Are you ready?
Developmental Disabilities Waiver - Form
December 14, 2023
Are you Ready for a Technology Screening Tool?
ETIP Form
Developmental Disabilities Waiver - Form
December 14, 2023
Enabling Technology Integration Plan
NM Guardianship Association Handbook June 2022
Constituent Support - Form
December 8, 2023
NM Guardianship Association Handbook June 2022
Types of Supported Decision Making
Constituent Support - Form
December 8, 2023
Types of Supported Decision Making