New Mexico Human Services Department Forms

This Form is used for enrolling in the New Mexico Hsd-Csed Prepaid Debit Card program. It is available in both English and Spanish.

This document is a form for applying for assistance in New Mexico.

This document is a basic visitation worksheet used in the state of New Mexico. It helps to establish and document visitation arrangements between parents or guardians.

This type of document is used for determining shared responsibility for taxes in the state of New Mexico.

This form is used for authorizing the release or obtaining of health information in the state of New Mexico. It allows individuals to give consent for healthcare providers to share or access their medical records.

This Form is used for authorizing the public release or obtaining of health information in New Mexico.

This form is used for applying to the Brain Injury Services Fund (BISF) Program in New Mexico. The program provides funding and services for individuals with brain injuries.

This form is used for conducting a self-assessment of a School-Based Health Center (SBHC) site in New Mexico. It helps evaluate the effectiveness and quality of services provided by the SBHC.

This form is used for requesting access to case record information in New Mexico. It is available in English and Spanish.

This form is used for referring refugees in New Mexico who are receiving Refugee Cash Assistance (RCA) to a voluntary resettlement agency.

This form is used for filing a complaint with the Income Support Division of New Mexico in both English and Spanish.

This form is used for determining presumptive eligibility for Medicaid in New Mexico. It has been recently updated.

This form is used for quality improvement assurance in the state of New Mexico. It is used to track and monitor quality improvement initiatives and ensure compliance with standards.

This Form is used for completing a Health Risk Assessment in New Mexico.

This form is used for completing a Health Risk Assessment (HRA) in the state of New Mexico. It is used to gather information about an individual's health status and identify potential health risks.

This Form is used to collect information for a Weighted Standardized Health Risk Assessment (HRA) in New Mexico.

This form is used for making a request to the Agency Based Community Benefits (ABCB) in New Mexico to terminate your participation in the Centennial Care program and switch from Self-directed Community Benefits (SDCB) to ABCB.

This form is used for denying claims for emergency medical services for aliens in New Mexico. It is available in both English and Spanish.

This document is for the Program of All-inclusive Care of the Elderly (PACE) in New Mexico. It is a long-term care medical assessment.

This form is used for authorizing Medicaid presumptive eligibility in the state of New Mexico.

This form is used for self-directed providers in New Mexico to attest to the requirements set forth by the CMS Final Rule for HCBS.

This Form is used for employers in New Mexico to assess their eligibility for the Centennial Care Self-directed Community Benefit Employer of Record program.

This Form is used for requesting a reduction in the community benefit budget for the Centennial Care Self-directed program in New Mexico.

This form is used for completing a service coordination assessment in New Mexico for the BISF program.

This Form is used for New Mexico residents to opt-in or opt-out of their Health Home program.

This Form is used for requesting an exception in the CNA (Certified Nursing Assistant) program in the state of New Mexico.

This document is used for the Long Term Care Medical Assessment Abstract for individuals with ICF/IID and developmental disabilities who are seeking home and community-based services waiver in New Mexico.

This Form is used for the MAD617 Bisf Service Coordination Intake Packet in New Mexico.

This Form is used for referring disability determination cases to the Disability Determination Unit in New Mexico.

This document is for Autism Evaluation Practitioners in New Mexico to attest their qualifications.

This document is an attestation template for the Behavior Analyst Certification Board. It is used in New Mexico for providers who are certified as Behavior Analysts or Behavior Analyst-Doctorates.