Forms
NMSIIS User Security and Confidentiality Agreement 2023
Immunization - Form
January 3, 2023
NMSIIS User Security and Confidentiality Agreement 2023
EMS Scope of Practice Addition or Deletion Suggestion Form
EMS Scope of Practice - Form
December 13, 2022
This form should be used for scope of practice addition or deletion suggestions.
Special Skills Annual/Semi-Annual Form
EMS Scope of Practice - Form
November 9, 2022
Special Skills Annual/Semi-Annual Form
Intravenous Therapy (IV) Certification
Certified Nurse Midwives and Licensed Midwives - Form
October 17, 2022
INTRAVENOUS THERAPY (IV) CERTIFICATION FORM
ECP – Progestin-Only Products Counseling Handout
Family Planning - Form
October 13, 2022
ECP - Progestin-Only Products Counseling Handout
ECP – Ulipristal Acetate Counseling Handout
Family Planning - Form
October 13, 2022
ECP – Ulipristal Acetate Counseling Handout
Sterilization – Instructions for Request and Consent Forms
Family Planning - Form
October 13, 2022
Sterilization – Instructions for Request and Consent Forms
Language Identification Flashcard
Family Planning - Form
October 13, 2022
Language Identification Flashcard
Contraceptive Spermicide (Film and Gel) – Counseling Handout
Family Planning - Form
October 12, 2022
Contraceptive Spermicide (Film and Gel) – Counseling Handout
Contraceptive Spermicide (Film and Gel) – Instructions
Family Planning - Form
October 12, 2022
Contraceptive Spermicide (Film and Gel) – Instructions
Contraceptive Implant – Consent Form
Family Planning - Form
October 11, 2022
Contraceptive Implant – Consent Form
Contraceptive Implant – Counseling Handout
Family Planning - Form
October 11, 2022
Contraceptive Implant – Counseling Handout
Birth Control Pills COCs – Counseling Handout
Family Planning - Form
October 11, 2022
Birth Control Pills COCs – Counseling Handout
COVID-19 Vaccine Troubleshooting Report
Immunization - Form
August 24, 2022
COVID-19 Vaccine Troubleshooting Report
NM J-1 Waiver Application 2024
Primary Care & Rural Health - Form
August 17, 2022
The New Mexico J-1 waiver 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.
VFC School Immunization Consent Form
Immunization - Form
August 17, 2022
This is the form to be completed by parents or guardians indicating whether or not a child is to be vaccinated at school.
Hepatitis B Immune Globulin (HBIG) Reporting Form
Perinatal Hepatitis B Prevention - Form
August 9, 2022
Please complete this information on every newborn receiving hepatitis B immune globulin (HBIG).
CDC-Revised document as COVID-19 Vaccine Program Provider Agreement
Immunization - Form
May 18, 2022
CDC-Revised document as COVID-19 Vaccine Program Provider Agreement
CDC-Supplemental document as COVID-19 Vaccine Redistribution Agreement
Immunization - Form
May 18, 2022
CDC-Supplemental document as COVID-19 Vaccine Redistribution Agreement