Forms

IR 9000 Online Recertification Application Breath Alcohol - Form May 13, 2026

IR 9000 Online Recertification Application

Candidate Questionnaire Form Community Health Workers - Form May 13, 2026

Form for potential CHW board members

NM Department of Public Safety Authorization Form Community Health Workers - Form May 13, 2026

Authorization form for CHW Board applicants

SLD 2026 IR (Infrared) 9000 Training Schedule Breath Alcohol - Form May 5, 2026

Use this form to request online training.

Documentation of Observed Family Planning Procedures Family Planning - Form April 7, 2026

Documentation of Observed Family Planning Procedures

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

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