Forms
NMSIIS Decline to Participate Form
Immunization - Form
December 30, 2021
This form is used by a patient/parent/legal guardian to decline to participate in the New Mexico Statewide Immunization Information System.
FY25 Admission Required Information
Veterans' Home - Form
December 27, 2021
FY25 Admission Required Information
Midwife Reporting Form
Children's Medical Services - Form
December 8, 2021
This form is used by midwives to record their audiological results or to refer parents to a doctor who will follow screen and follow the baby. This form is then submitted to the New Mexico Department of Health.
Newborn Hearing Screening Referral Form
Children's Medical Services - Form
December 8, 2021
This form is used to refer parents to a doctor for a newborn hearing screening.
New Mexico Midwifery Student Workbook 2022
Certified Nurse Midwives and Licensed Midwives - Form
November 18, 2021
New Mexico Midwifery Student Workbook 2022
Adult Vaccine Consent Form
Immunization - Form
October 1, 2021
This form may be used by adult patients aged 19 and older to provide vaccination consent to a healthcare provider.
Birth Control Pills COCs – Missed Pill Instructions
Family Planning - Form
September 27, 2021
Birth Control Pills COCs – Missed Pill Instructions
Birth Control Pills POPs – Counseling Handout
Family Planning - Form
September 27, 2021
Birth Control Pills POPs – Counseling Handout
Birth Control Pills POPs – Missed Pill Instructions
Family Planning - Form
September 27, 2021
Birth Control Pills POPs – Missed Pill Instructions
Vaginal Contraceptive Ring – Counseling Handout
Family Planning - Form
September 27, 2021
Vaginal Contraceptive Ring – Counseling Handout
Condoms (External) – Counseling Handout
Family Planning - Form
September 27, 2021
Condoms (External) – Counseling Handout
Condoms (Internal) – Counseling Handout
Family Planning - Form
September 27, 2021
Condoms (Internal) – Counseling Handout
Lactational Amenorrhea Method (LAM) – Counseling Handout
Family Planning - Form
September 27, 2021
Lactational Amenorrhea Method (LAM) – Counseling Handout
Abstinence – Counseling Handout
Family Planning - Form
September 27, 2021
Abstinence – Counseling Handout
Sterilization – Counseling Handout
Family Planning - Form
September 25, 2021
Sterilization – Counseling Handout
DMPA – Sub-Q Disposal of Needles and Unused Medication Handout
Family Planning - Form
September 25, 2021
DMPA – Sub-Q Disposal of Needles and Unused Medication Handout