Forms
Occupational Health Case Reporting
Occupational Health Surveillance - Form
March 15, 2018
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.
VFC Approved School Sites - Needle, Syringe, & e-kit Order Form
Immunization - Form
February 23, 2018
This form is to be used for needles/syringes, and e-kit medications and is for Vaccines for Children Approved Sites Only.
VFC Middle School Vaccination Letter/Permission Form
Immunization - Form
February 23, 2018
This is the letter addressed to parents or legal guardians to determine whether or not a child is to be vaccinated at school. This letter is to be sent out with the VFC school immunization consent form.
VFC Middle School Vaccination Letter/Permission Form (Spanish)
SHM - Chapter 1 - Supervisory School Nurse Performance Evaluation Tool for Medical Supervisors
School and Adolescent Health - Form
February 13, 2018
SHM - Chapter 1 - Supervisory School Nurse Performance Evaluation Tool for Medical Supervisors
VFC Program Data Logger Timeline and Checklist
Immunization - Form
January 26, 2018
This document is for providers: guidelines and important dates for the transition to digital data loggers.
SHM - Chapter 2 - Adverse Event Form
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 2 - Adverse Event Form
SHM - Chapter 3 - Health History Form (Initial)
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 3 - Health History Form (Initial)
SHM - Chapter 3 - Hearing Screening Form
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 3 - Hearing Screening Form
SHM - Chapter 3 - Release of Medical Information Form (Parents)
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 3 - Release of Medical Information Form (Parents)
SHM - Chapter 3 - General Referral Form
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 3 - General Referral Form
SHM - Chapter 3 - Release of Medical Information Form (Sample)
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 3 - Release of Medical Information Form (Sample)
SHM - Chapter 3 - Save Our Children’s Sight Voucher Form
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 3 - Save Our Children’s Sight Voucher Form
SHM - Chapter 3 - Special Ed Nurse Screen Summary Form
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 3 - Special Ed Nurse Screen Summary Form
SHM - Chapter 4 - Asthma Management Plan Initial Assessment Form
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 4 - Asthma Management Plan Initial Assessment Form
SHM - Chapter 4 - Confidential Nursing Report Form
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 4 - Confidential Nursing Report Form
SHM - Chapter 4 - Diabetes Emergency Care Plan Form
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 4 - Diabetes Emergency Care Plan Form
SHM - Chapter 4 - Diabetes Emergency Response Plan Form
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 4 - Diabetes Emergency Response Plan Form
SHM - Chapter 4 - Diabetes Medical Management Plan Form
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 4 - Diabetes Medical Management Plan Form
SHM - Chapter 4 - DNR Form for EMS (State Version)
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 4 - DNR Form for EMS (State Version)
SHM - Chapter 4 - School Nurse Asthma Assessment Tool
School and Adolescent Health - Form
January 25, 2018
SHM - Chapter 4 - School Nurse Asthma Assessment Tool