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Photo of the publication cover. Work Experience Grant Program Community Inclusion - Form May 16, 2018

Work Experience Grant Program



Photo of the publication cover. DDW Exception Authorization Form Regional Offices - Form May 15, 2018

Regional Office form used by a CM or provider agency to request an exception to the DD Waiver Service Standards that directly impacts a person in service or relates to service and/or agency requirements.



Photo of the publication cover. Mi Via Self-Directed Waiver: Service and Support Back-Up Plan Acknowledgement Form Mi Via Self-Directed Waiver - Form April 18, 2018

Mi Via Self-Directed Waiver: Service and Support Back-Up Plan Acknowledgement Form



Photo of the publication cover. Medical Cannabis License ID Card Request Medical Cannabis Program - Form April 9, 2018

This form should be used to request a card for all new Licensed Nonprofit Producer employees, Board Members, or contract worker or to request a replacement card for one of these staff members. For a new employee card please ensure you submit the items requested on the form.



Photo of the publication cover. CMS Telephone Referral Form Children's Medical Services - Form April 5, 2018

CMS Telephone Referral Form



Photo of the publication cover. VFC New Provider Application Immunization - Form March 23, 2018

All VFC providers are required to submit this annual VFC certification form in order to continue receiving VFC vaccines.

VFC Instructions on Digital Signature and Attaching License



Photo of the publication cover. Occupational Health Case Reporting Occupational Health Surveillance - Form March 15, 2018

This confidential case reporting form allows health care providers and lab directors to meet the requirements of the law by reporting occupational and/or injuries to the New Mexico Occupational Health Surveillance Program (OHSP) within 24 hours. Additional instructions for reporting a case are contain within the document.



Photo of the publication cover. HCBS Acknowledgement for Consumer Rights and Freedoms Form Developmental Disabilities - Form March 7, 2018

Signing this form is acknowledgement that the HCBS Consumer Rights and Freedoms document has been received, explained and signed.

HCBS Consumer Rights and Freedoms



Photo of the publication cover. DDW Case Management: OR Budget Worksheet for Adults Sample Developmental Disabilities Waiver - Form February 23, 2018

DDW Case Management: OR Budget Worksheet for Adults Sample



Photo of the publication cover. VFC Approved School Sites - Needle, Syringe, & e-kit Order Form Immunization - Form February 23, 2018

This form is to be used for needles/syringes, and e-kit medications and is for Vaccines for Children Approved Sites Only.



Photo of the publication cover. VFC Middle School Vaccination Letter/Permission Form Immunization - Form February 23, 2018

This is the letter addressed to parents or legal guardians to determine whether or not a child is to be vaccinated at school. This letter is to be sent out with the VFC school immunization consent form.

VFC Middle School Vaccination Letter/Permission Form (Spanish)



Photo of the publication cover. Medical Emergency Response Plan Form (side-by-side format) Clinical Services - Form February 22, 2018

Medical Emergency Response Plan Form (side-by-side format)



Photo of the publication cover. Medical Emergency Response Plan Form (standard format) Clinical Services - Form February 22, 2018

Medical Emergency Response Plan Form (standard format)



Photo of the publication cover. VFC Troubleshooting Record Form Immunization - Form February 16, 2018

This form should be used to report out of range temperature incidents and submit a troubleshooting record to the vaccines for children program.





Photo of the publication cover. SHM - Chapter 1 - Associate School Nurse Evaluation Tool for Medical Supervisors School and Adolescent Health - Form February 13, 2018

SHM - Chapter 1 - Associate School Nurse Evaluation Tool for Medical Supervisors



Photo of the publication cover. SHM - Chapter 1 - Licensed Practical Nurse Performance Evaluation for Nurse Supervisors School and Adolescent Health - Form February 13, 2018

SHM - Chapter 1 - Licensed Practical Nurse Performance Evaluation for Nurse Supervisors



Photo of the publication cover. SHM - Chapter 1 - Professional School Nurse Evaluation Tool for Medical Supervisors School and Adolescent Health - Form February 13, 2018

SHM - Chapter 1 - Professional School Nurse Evaluation Tool for Medical Supervisors



Photo of the publication cover. SHM - Chapter 1 - School Health Assistant Performance Evaluation Tool for Nurse Supervisors School and Adolescent Health - Form February 13, 2018

SHM - Chapter 1 - School Health Assistant Performance Evaluation Tool for Nurse Supervisors



Photo of the publication cover. SHM - Chapter 1 - Nurse Performance Evaluation Tool for Non-Medical Administrators School and Adolescent Health - Form February 13, 2018

SHM - Chapter 1 - Nurse Performance Evaluation Tool for Non-Medical Administrators

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