New mexico authorization form 2026

1. Click ‘Get Form’ to open the New Mexico Authorization Form in the editor.
2. Begin by entering your full name and date of birth in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Provide your Social Security Number, but remember to only enter the last four digits for privacy.
4. Fill in the date(s) of injury and WCA case file number if applicable. This helps in tracking your claim effectively.
5. In the 'Release of Health Care Records' section, specify the health care provider or facility authorized to release your records. Include their address and telephone number.
6. Select whether you want all records released or specific dates by checking the appropriate box and providing any necessary date ranges.
7. If applicable, check any boxes that pertain to sensitive health information that may be included in your records.
8. Sign and date the form at the bottom, ensuring that you also include a signature from a personal representative if needed.

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