Practitioner Support

This site is dedicated to support the CAM community in understanding and implementing the New Mexico "Unlicensed Health Care Practice Act". We hope to provide the CAM community with some useful information. Below you will find documents that we hope will give you a head start in developing your own paperwork.

Documents to Download

Patient Information Document Checklist:

The Patient Information Document is required of all unlicensed health care practitioners in NM.  This checklist is taken word for word from the New Mexico Unlicensed Health Care Practice Act and reformatted so that practitioners may more easily create their own document incorporating all the required statements.

Download Patient Information Document Checklist PDF document

Sample Patient Information Document:

This is a sample Patient Information Document incorporating all the required statements as an example of what your own might look like.

Download Sample Patient Information Word document

Sample Patient Recommendations Form:

This is a sample of a Patient Recommendation Form. It defines the goals and expected results (Section 5.4.), lists the recommendations to be incorporated, indicates for how long the recommendations are valid and requires the patient’s signature indicating receipt. It also documents that no recommendation was made to discontinue current medical treatment prescribed by a licensed health care practitioner in accordance with Section 4.G.

Download Sample Patient Recommendations Form Word document

Sample Medical Referral Form:

This is a sample of a medical referral form. According to Section 4.H. an unlicensed health care practitioner may not make a specific conventional medical diagnosis. However, it seems prudent that a complementary and alternative health care practitioner may indicate to the client that he or she has a concern that the client might be predisposed to or may have a certain condition and should go to a licensed health care provider. This document can be used to indicate this concern.

Download Sample Medical Referral Form

We are not attorneys or experts, the information on this site should not be taken as legal advice. You should consult with an attorney or other expert as to how this statute pertains to you and your practice.