Forms
NMSIIS Organization Security and Confidentiality Agreement 2024
Immunization - Form
December 29, 2023
Participant organization security and confidentiality agreement for the New Mexico Statewide Immunization Information System.
NMSIIS User Security and Confidentiality Agreement 2024
Immunization - Form
December 29, 2023
NMSIIS User Security and Confidentiality Agreement 2024
VFC Northeast Region Temperature Log Form
Immunization - Form
October 23, 2023
Colfax, Guadalupe, Harding, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Taos, and Union
VFC Southwest Region Temperature Log Form
Immunization - Form
October 23, 2023
Catron, Dona Ana, Grant, Hidalgo, Luna, Otero, Sierra, and Socorro
VFC Routine Vaccine Management Plan
Immunization - Form
October 23, 2023
The New Mexico VFC Program requires each practice to develop and maintain a Routine Vaccine Management Plan. Properly completing this template will meet the VFC Program requirement for VFC Program participants to have written vaccine storage and handling plans.
VFC Emergency Vaccine Management Plan
Immunization - Form
October 23, 2023
The New Mexico VFC Program requires each practice to develop and maintain an Emergency Vaccine Management Plan. Properly completing this template will meet the VFC Program requirement to have a written plan for storage and handling procedures in an emergency.
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.
NMSIIS Organization Security and Confidentiality Agreement 2023
Immunization - Form
January 3, 2023
Participant organization security and confidentiality agreement for the New Mexico Statewide Immunization Information System.
NMSIIS User Security and Confidentiality Agreement 2023
Immunization - Form
January 3, 2023
NMSIIS User Security and Confidentiality Agreement 2023