Notice of Change of Health Care Provider Under Automatic Right of Second Selection - New Mexico 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the name of the party making the change in the designated field.
  3. Fill in the worker’s name and employer’s name, ensuring accuracy for proper identification.
  4. Provide both addresses and telephone numbers for the worker and employer, as this information is crucial for communication.
  5. Complete the insurance company details, including the representative's name and contact information.
  6. Indicate if there is a worker’s attorney or employer’s attorney, along with their respective addresses.
  7. Document the date and county of the accident, as well as type of injury sustained.
  8. List your current health care provider's details followed by those of the proposed health care provider, ensuring they are licensed in New Mexico.
  9. Finally, sign and date the notice at the bottom to validate your submission.

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