Forms

Occupational Health Case Reporting Occupational Health Surveillance - Form August 4, 2026

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.

NM J-1 Waiver Application 2027 Primary Care & Rural Health - Form July 8, 2026

The New Mexico J-1 Waiver Program (State 30 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.

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Attachment C

DMPA – Sub-Q Disposal of Needles and Unused Medication Handout Family Planning - Form July 2, 2026

DMPA – Sub-Q Disposal of Needles and Unused Medication Handout

Sliding Fee Scale Family Planning - Form July 1, 2026

Sliding Fee Scale

NM 2026 Morbidity Report Sexually Transmitted Diseases - Form July 1, 2026

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.

Sterilization - Consent Form (English) Family Planning - Form June 24, 2026

Sterilization - Consent Form (English)

Sterilization - Consent Form (Spanish) Family Planning - Form June 24, 2026

Sterilization - Consent Form (Spanish)

Complaints against Doulas Maternal Health - Form May 26, 2026

Complaints against Doulas

Midwife Complaint Form - 2026 Certified Nurse Midwives and Licensed Midwives - Form May 21, 2026

Use this form to file a complaint against a midwife.

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.

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