Forms
Turquoise Lodge Authorization to Disclose Health Information Form
Turquoise Lodge Hospital - Form
May 18, 2022
This form should be used to authorize the disclosure of health information for patients.
PHD Assignment of Benefits and Consent Form
Family Planning - Form
April 14, 2022
Assignment of Benefits and Consent Form
LM Annual Report
Certified Nurse Midwives and Licensed Midwives - Form
February 3, 2022
LM Annual Report
Electronic Certifier Training Request Form
Vital Records - Form
January 21, 2022
Electronic Certifier Training Request Form
OCHW Registration Form - Deadline Feb 4, 2022
Community Health Workers - Form
January 12, 2022
OCHW Registration Form - Deadline Feb 4, 2022
MWP Student/ Instructor Relationship Form
Certified Nurse Midwives and Licensed Midwives - Form
January 11, 2022
MWP Student/ Instructor Relationship Form
Affidavit of Review of a Certified New Mexico Birth Certificate
Vital Records - Form
December 30, 2021
This form is to be used by agencies and organizations to document eligibility. This should not be accepted in place of a birth certificate.
NMSIIS Decision to Remove Record
Immunization - Form
December 30, 2021
This form is used by a patient/parent/legal guardian to remove records from the New Mexico Statewide Immunization Information System.
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
New Mexico Midwifery Student Workbook 2022
Certified Nurse Midwives and Licensed Midwives - Form
November 18, 2021
New Mexico Midwifery Student Workbook 2022
