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New Mexico Medical Society

Introduction and Description

The New Mexico Medical Society is pleased to make available to you The New Mexico Statewide Application For Physician/Practitioner Appointment©. This form was developed in 1996 by the New Mexico Medical Society and The New Mexico Hospitals and Health Systems Association, in a joint effort to offer providers a tool that possesses the flexibility to accommodate the unique needs of all integrated health care systems. The statewide application is available to all entities requiring credentials verifications, such as IPA’s, HMO’s, PPO’s, MCO’s, as well as hospitals and other health care facilities. For physicians and office staff, this means less paperwork, the elimination of multiple verification applications, and streamlined appointment and reappointment procedures.

If you or your organization is interested in utilizing The New Mexico Statewide Application For Physician/Practitioner Appointment ©, you may download the application form as a Microsoft Word document from this website. Please follow the instructions below for downloading and printing the form.

Printed Application Form Request

You may of course also request printed copies of the application form from the New Mexico Medical Society or the New Mexico Hospital Association. Physicians may now do this most conveniently using this online form:

I would like to request a copy of the
The New Mexico Statewide Application
For Physician/Practitioner Appointment©
PHYSICIAN NAME:
MAILING ADDESS:
E-MAIL (Required):

Updates

This form will be updated as needed to ensure that it complies with the latest Joint Commission on Accreditation of Healthcare Organization standards and the National Committee for Quality Assurance guidelines, and meets the needs of the organizations using it.

Form most recently updated: July, 1999. Please discard any earlier versions, and download the current version.

Users List

A growing Users List of health care facilities throughout New Mexico have agreed to use this application for their practitioner appointments and/or accept the statewide application in place of their own facilities' form. The Users List is being continuously updated; please recheck this list online any time you need to complete a credentials application to see if you may use this form.

If your organization would like to be added to the Users’ List, please contact Ms. Kristi Beck at (800)577-2121 or (505)343-0070. All those organizations listed on the Users’ List receive a hard copy of the application as it is updated to ensure they are always in receipt of the latest version of the form.

Instructions for Downloading and Printing

the The New Mexico Statewide Application For Physician/Practitioner Appointment © :
  1. The form is available in Microsoft Word 6.0, which works with all versions from Office 95 onwards.
  2. Click on the "Download Application Form" link below.
  3. Depending on your browser program, you will get a dialogue box giving you several options. Click on "Save" or "Save File"; ignore any questions about extending your browser's capabilities.
  4. The "Save" option should then allow you to specify where you want the file to reside on your computer. It will download with the filename: "nm_app.doc" [file size = 721KB; download time will vary depending on the speed of your modem and how you're connected to the Net, but should be less than about 5 minutes].
  5. After successful download, close your browser, and start Microsoft Word. Open "nm_app.doc" from Microsoft Word. There are two different ways the credentials application form can be used:
    • As hard copy:
      • Print the file.
      • Complete the printed hard copy of the form with pen or typewriter.
    • As a computer template:
      • Under MS Word, save the form as a "template"
      • Make a separate copy of the template file for each physician for whom the form will be used, and fill in the data on your computer. If you are able to do this, this is the optimal way of taking advantage of having this form available online, since you are now able to maintain and update the data on your computer, and print out an updated copy of the form any time it's needed. BUT PLEASE NOTE:
      • If you are using the form as a template file, please make certain that you are only using the most recent version of the form.

Download

[Download Credentials Application Form]


NMMS Homepage

The New Mexico Statewide Application for Practitioner Appointment© is endorsed by the New Mexico Medical Society and The New Mexico Hospitals & Health Systems Association and complies with JCAHO standards and NCQA guidelines.
Credentials application form last updated: 7/99

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New Mexico Medical Society
Feedback to Webmaster is greatly appreciated.
  Copyright © 1998-2009 New Mexico Medical Society, all rights reserved.

This page last updated on Jun 26, 2006.