Workers' comp reports, MVD driver and placard forms, the uniform prior authorization form, sports physicals and public health reports from New Mexico agencies.
New Mexico's forms come from the Workers' Compensation Administration, the Motor Vehicle Division, the Office of Superintendent of Insurance and the Department of Health. Clinicians meet these most: the New Mexico Uniform Prior Authorization Form, the WCA Provider's Report of Physical Ability (the PROPA form), the MVD Vision Report (MVD-10125), the parking placard certificate (MVD-10383) and the NMAA preparticipation exam. This page lists all 18 New Mexico forms, grouped by program.
One uniform prior authorization form covers health care services and prescription drugs with New Mexico health plans, and NM Medicaid and the Turquoise Care MCOs use it too. Give the worker a copy of the PROPA right after each visit. For the NMAA physical, only the Medical Eligibility Form goes to the school. A medical exemption from school immunizations needs a provider's letter attached to the parent's notarized NMDOH certificate. Spanish versions exist for 2 of these forms.
Gives a quantitative description of claim-related physical restrictions, work status, diagnosis work-relatedness and MMI so the employer can offer safe return-to-work activities.
Standard questionnaire a party sends to the treating provider asking for diagnosis, causation, MMI, impairment rating, FCE, work and activity restrictions and referrals, answered to a reasonable medical probability.
Asks the WCA Medical Cost Containment Bureau to conduct utilization review of disputed medical care on a claim.
MVD-10125Eye doctor reports acuity, fields (120 degrees horizontal), progressive conditions, restrictions and renewal interval for a driver who failed the MVD vision test.
MVD-10124Physician reports conditions (neurological, cardiovascular, diabetes, dementia, epilepsy, loss of consciousness, etc.), capability to drive, restrictions and renewal interval for a Class D/E/M license, permit or provisional license; reviewed by the Medical Advisory Board.
Physician certifies a significant mobility limitation (Section 66-3-16 NMSA) and whether it is permanent or temporary (up to 12 months) for a parking placard.
Required sports physical packet for all NMAA pre-participation examinations, based on the PPE monograph.
Certificate of Exemption from Immunization (Spanish)
Parent request to NMDOH for a medical or religious exemption from school/daycare immunizations; medical requests must attach a licensed provider's letter.
Medical documentation required by 7 CFR 246.10(d) for WIC to issue exempt infant formula, WIC-eligible nutritionals or non-contract formula, and to modify WIC foods, for a participant with a qualifying medical condition.
Referral to WIC with the provider's anthropometric and lab data (height/length, weight, hemoglobin) and nutrition-risk information, used to certify the patient for WIC.
Standardized out-of-hospital do-not-resuscitate order that authorizes EMS providers to withhold resuscitation under NMAC 7.27.6.
Prescribing provider reports each aid-in-dying prescription under the Elizabeth Whitefield End-of-Life Options Act (demographics, hospice status, condition, ingestion).
Medical provider certifies a qualifying condition and starts the patient's Medical Cannabis Program enrollment application online.
Clinician report of a diagnosed or treated case of syphilis, gonorrhea, chlamydia or chancroid, including treatment and expedited partner therapy, to the NMDOH STD Program.
Clinician/facility report of a notifiable infectious disease or condition (NMAC 7.4.3.13) to the NMDOH Infectious Disease Epidemiology Bureau.
Online report of suspected abuse, neglect or exploitation of an adult (18+) who cannot protect themselves, for APS intake.
Physician statement of permanent restriction to a wheelchair/walker/crutches or permanent conditions that substantially limit walking, required before applying for mobility-impaired-only pronghorn, deer, elk and oryx hunts.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Yes. The Office of Superintendent of Insurance's New Mexico Uniform Prior Authorization Form covers health care services and prescription drugs, including formulary and step-therapy exceptions. Plans insert their own web address and fax number. The ordering provider or prescriber completes priority, enrollee, provider, the service or medication, clinical rationale and previous therapy, then files it electronically or by fax. NM Medicaid and the Turquoise Care MCOs use it too.
The WCA Provider's Report of Physical Ability. The primary treating provider describes claim-related physical restrictions, work status, whether the diagnosis is work-related, and MMI, so the employer can offer safe return-to-work activities. Give the worker a copy right after each visit and send one to the employer or insurer. It does not replace a functional capacity evaluation. Completion is reimbursable only at the initial assessment or when work status or restrictions change.
A licensed physician completes Parts C and D, certifying a significant mobility limitation under Section 66-3-16 NMSA and whether it is permanent or temporary, up to 12 months. The applicant presents the form at an MVD field office or partner. Renewals and replacements use Part E and do not need a new physician section.
Online only. A New Mexico-licensed practitioner authorized to prescribe controlled substances, such as an MD, DO, CNP or PA, first completes a Medical Provider application. The provider then starts the patient's application in the Online Patient Portal and certifies a qualifying condition, and the patient completes the rest. Only medical providers can start an application. Write-in conditions are not accepted; other conditions go through Medical Advisory Board petitions.