Forms
NM J-1 Waiver Application 2024
Primary Care & Rural Health - Form
August 2, 2023
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.
EOL1 – Medical Aid in Dying Reporting Form
Vital Records - Form
August 2, 2023
EOL1 – Medical Aid in Dying Reporting Form
DD Waiver (HCBS) Application (Spanish)
Eligibility Determination - Form
August 1, 2023
DD Waiver (HCBS) Application (Spanish)
DD Waiver (HCBS) Application
Eligibility Determination - Form
July 31, 2023
DD Waiver (HCBS) Application
NMHSC Stipend Application for 2023
Primary Care & Rural Health - Form
July 17, 2023
The New Mexico Health Service Corps provides stipends to eligible health professionals during their last two years of training or residency who, in turn, enter into contract with the Department of Health to provide (when licensed) health service for a minimum of two years (1600 hours per year) in an underserved area of New Mexico. This document is the application for this program.
NMHSC Stipend Applicant Reference Report for 2023
Primary Care & Rural Health - Form
July 3, 2023
NMHSC Stipend Applicant Reference Report for 2023
HIV/AIDS Confidential Case Reporting Form
HIV Surveillance & Epidemiology - Form
June 27, 2023
Use this form to confidentially report a case of HIV/AIDS.
Community Health Worker Continuing Education Unit Provider Application
Community Health Workers - Form
June 21, 2023
This is the application to become an approved Continuing Education Unit Provider.
Community Health Worker State Certification Renewal Application
Community Health Workers - Form
June 21, 2023
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
Breath Alcohol Test Operator Training Request Form
Breath Alcohol - Form
June 14, 2023
Use this form to request test operator training.
Breath Alcohol Key Operator Training Request Form
Breath Alcohol - Form
June 14, 2023
Use this form to request key operator training.
Breath Alcohol Training Cancellation Notification Form
Breath Alcohol - Form
June 14, 2023
Use this form to cancel training requests.
STD Case Reporting Form
Sexually Transmitted Diseases - Form
June 8, 2023
All STD cases diagnosed or treated in New Mexico are required by law to be reported to the STD Program in Santa Fe. Additionally, any medical laboratory anywhere in the United States performing testing for New Mexico must report positive results to the New Mexico STD Program in Santa Fe.
VFC Provider Staff Change of Contact and uploading Training
Immunization - Form
April 13, 2023
VFC Provider Staff Change of Contact and uploading Training
VFC Physician Signing Agreement Change of Contact
Immunization - Form
April 13, 2023
VFC Physician Signing Agreement Change of Contact
VFC New Provider Application
Immunization - Form
April 13, 2023
All VFC providers are required to submit this annual VFC certification form in order to continue receiving VFC vaccines.
VFC Provider NM Health Passport Order Form
Immunization - Form
April 13, 2023
This form allows providers to order VFC supplies.
Cover Sheet for Audiological Reports
Children's Medical Services - Form
April 11, 2023
Cover Sheet for Audiological Reports
Pharmacist Telehealth Consent Form
Family Planning - Form
March 21, 2023
Pharmacist Telehealth Consent Form
Pharmacist Telehealth Consent Form
Pharmacist Telehealth Consent Form - Spanish