Forms

This form allows parents to request a gender designation change on their child's birth certificate.

This additional form is required to request a gender change on a birth certificate if the registrant is 40 years of age or over.

This authorization allows the Department of Health (DOH) to disclose confidential health information about you. The authorization may be revoked. It will remain in effect for six (6) months unless a different time is stated. You are entitled to a copy of the completed authorization. There may be fees charged for any copying associated with this request. If you are a person with a disability and you require this authorization in an alternative format or require a special accommodation to complete this form, you may request assistance from staff at any DOH location or from the DOH Chief Privacy Officer.

Authorization to Disclose Health Information (Spanish)

Therapy Services: Discontinuation of Therapy Report (Template)

Prefilled Specimen Submission Form for norovirus testing (raw stool)

Prefilled Specimen Submission Form for enteric bacteria testing (transport media)

ACQ Authorization Form for Appointments

This is the fillable form reference tool for THERAP.

Fill out this application to apply for admission to the New Mexico State Veterans' Home.

FIT Developmental Specialist Recertification Application

FIT Developmental Specialist Initial Certification Application

Access to public records is one of the fundamental rights afforded people in a democracy. Even where there is no statute, a common law right to inspect and copy public records affords members of the public the opportunity to keep a watchful eye on government. In accordance with the Inspection of Public Records Act by the New Mexico Attorney General, you may use this form to submit a formal request to inspect public records.

This form should be completed to determine financial eligibility for adult patients.

Radio Frequency Interference Check - Intoxilyzer 8000

Use this form to report Abuse, Neglect & Exploitation in community-based medicaid waiver programs.

Application for CMP Funds

This action plan form was created by the New Mexico Council on Asthma (NMCOA) for school nurses, health care providers and families. It allows for an individual action plan to be developed for each student to ensure proper handling of asthma based on severity.

Plan de acción contra el asma para las Escuelas

The pictorial asthma action plan is a patient education tool intended to supplement the asthma action plan. It is designed to engage children and families in asthma self-management and improve overall measures of asthma control.

Plan Gráfico de Acción de Asma

This is the Community Health Worker State Certification Specialty Track Advanced Application.

Aplicación para la Certificación Estatal como Especialistas Avanzados

This is the application detailing required documentation, eligibility requirements, and submission guidelines for Community Health Worker state certification.

Aplicación para la Certificación Estatal de los Trabajadores de la Salud Comunitaria