Forms
Community Health Worker State Certification Renewal Application
Community Health Workers - Form
January 30, 2019
This is the application detailing required documentation, eligibility requirements, and submission guidelines for Community Health Worker state certification renewal.
Solicitud de Renovación de Certificación Estatal de Trabajadores de Salud Comunitarios
Community Health Workers State Certification Application
Community Health Workers - Form
January 24, 2019
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
Sample Collection Kit Order Form
Kit Preparation - Form
November 2, 2018
Use this form to order sample collection kits.
Track Your Child's Development - Checklist
Maternal & Child Health Epidemiology - Form
October 26, 2018
This is a checklist that allows you to fill out your child's name, age, and date and then check off the milestones your child has already achieved.
EMS Renewal License Continuing Education Breakdown
EMS Continuing Education - Form
October 19, 2018
This form is for those who apply for renewal and are being audited. Fill it out to identify the category and quantity of continuing education for the required levels of licensure.
School Consent to Enter Student Records into NMSIIS
Immunization - Form
September 17, 2018
This is a customizable form for use by schools to collect consent from parents so students' historic immunization records may be added to NMSIIS.
Breath Alcohol Training Cancellation Notification Form
Breath Alcohol - Form
September 14, 2018
Use this form to cancel training requests.
Chemistry Analysis Request Form
Chemistry - Form
July 16, 2018
Use this form to request general chemistry analysis.
CMS Telephone Referral Form
Children's Medical Services - Form
April 5, 2018
CMS Telephone Referral Form
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