Forms

This form should be used by all healthcare professionals to report pesticide related illness and injury of workers in New Mexico to the Occupational Health Surveillance Program. It includes a list of questions you can ask your patients and the symptoms of pesticide exposure are also listed in both English and Spanish.

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.

This form is used to report Hepatitis Pregnancy

Birth-HBIG Reporting Form

Pediatric Vaccination Reporting Form

Complete this log when transporting vaccines to an alternate or back-up refrigerator, or when transferring to another provider.

Use this form to request a birth certificate.

Solicitud de Acta de Nacimiento

Use this form to request a death certificate.

Solicitud de Acta de Defunción

Establishment of paternity means the establishment of the parent-child relationship. This Acknowledgment of Paternity (AOP) shall be signed under penalty of perjury by the mother and by the man seeking to establish paternity.

Reconocimiento de Paternaty

Use this form to request online training.

Use this form to request online training.

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

Use this form to request online training.

Use this form to request online training.

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.

NMHSC Stipend Program Guidelines for 2024 - 2025

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.

Use this form to request drug-facilitated sexual assault toxicology analysis.

This form is used by a patient/parent/legal guardian to remove records from the New Mexico Statewide Immunization Information System.

NMSIIS Decision to Remove Record (Spanish)