Forms

EMS Do Not Resuscitate Form EMS Advance Directives - Form February 18, 2026

This form is to place a formal Do Not Resuscitate order. For covered persons in cardiac or respiratory arrest, resuscitative measures to be withheld include external chest compressions, intubation, defibrillation, administration of cardiac medications and artificial respiration.

EMS Medical Orders for Scope of Treatment Form EMS Advance Directives - Form February 17, 2026

This form should be used by a physician to outline a plan of care respecting the patient’s wishes concerning care at life’s end.

EMS Medical Orders for Scope of Treatment Instructions

Certificate of Exemption from Immunization (English) Immunization - Form January 26, 2026

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.

Certificate of Exemption FAQ

Certificate of Exemption from Immunization (Spanish) Immunization - Form January 20, 2026

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.

New Mexico Sexually Transmitted Disease Morbidity Form Sexually Transmitted Diseases - Form December 18, 2025

New Mexico Sexually Transmitted Disease Morbidity Form

Radio Frequency Interference Check - Intoxilyzer 9000 Breath Alcohol - Form December 10, 2025

Radio Frequency Interference Check - Intoxilyzer 9000

SLD 2026 IR (Infrared) 9000 Training Schedule Breath Alcohol - Form December 2, 2025

Use this form to request online training.

TB Risk Assessment Form Tuberculosis Prevention - Form November 20, 2025

TB Risk Assessment Form

Sterilization – Request Form Family Planning - Form November 18, 2025

Sterilization – Request Form

NMDOH Certified Doula Manual Application Maternal Health - Form October 20, 2025

Manual application for the NMDOH Doula certification.

Referring to UNM for Breast or Cervical Services Breast and Cervical Cancer - Form August 27, 2025

Referring to UNM for Breast or Cervical Services

National Breast Cancer Foundation Grant Referral Breast and Cervical Cancer - Form August 27, 2025

National Breast Cancer Foundation Grant Referral

BCC Coverage At-A-Glance Breast and Cervical Cancer - Form August 27, 2025

BCC Coverage At-A-Glance

New Provider Application Breast and Cervical Cancer - Form August 26, 2025

BCC Program New Provider Application Documents - New Provider Application

Provider Contact Form Breast and Cervical Cancer - Form August 26, 2025

BCC Program New Provider Application Documents - Provider Contact Form

Provider Credential List Breast and Cervical Cancer - Form August 26, 2025

BCC Program New Provider Application Documents - Provider Credential List

FY26 Eligibility and Consent Form (English) Breast and Cervical Cancer - Form August 26, 2025

FY26 Eligibility and Consent Form (English)

FY26 Eligibility and Consent Form (Spanish)
FY26 Screening and Referral Form

FY26 Clinic Based Patient Navigation Form Breast and Cervical Cancer - Form August 26, 2025

FY26 Clinic Based Patient Navigation Form (Print Version)

FY26 Clinic Based Patient Navigation Form (PDF Fillable Version)

Midwife Complaint Form Certified Nurse Midwives and Licensed Midwives - Form August 19, 2025

Use this form to file a complaint against a midwife.

VFC Vaccine Administration Form (Part B) Immunization - Form August 13, 2025

This form allows you to provide immunization information for entry into NMSIIS.

VFC Vacuna Forma Administración (Parte B)