N.M. Admin. Code § 20.3.20.500

Current through Register Vol. 36, No. 1, January 14, 2025

Section 20.3.20.500 - DEPARTMENT FORMS, CONFIDENTIALITY, AND RELEASE OF PERSONAL IDENTIFICATION

A. Department forms required.

(1) An individual seeking licensure or any other services listed in this part shall submit a completed application form and applicable fee to the department.

(2) The department shall create and make available all necessary application forms.

(3) The department's forms may request such personal identification as is required to perform the department's duties under the act and this part including, but not limited to: name, mailing address, telephone numbers, email address, certifications, licenses, date of birth, and social security number.

(4) No application shall be complete unless it is on the form prescribed by the department and includes, in legible format:

(a) all required personal identification;

(b) copies of all supporting documents specified on the form;

(c) full payment of required fees by a method specified on the form; and

(d) date and signature of the applicant.

B. Confidentiality of personal identification. Personal identification collected by the department shall not be disclosed except:

(1) in the performance of the department's duties under the act or this part;

(2) as provided in this part or as required by state or federal law; or

(3) in response to a valid subpoena or court order.

C. Release of licensee personal identification. Unless otherwise provided by law, the department shall only release a licensee's name, mailing address, department registration number, and verification of license and subspecialty. The department may release information related to an application denial or license revocation or suspension to a credentialing organization. In accordance with federal law, the department shall release any required information related to revocation or suspension of a licensee to the national practitioner data bank.

N.M. Admin. Code § 20.3.20.500

20.3.20.500 NMAC - Rp, 20 NMAC 3.2.V.500 - V.502, 8/31/2005, Adopted by New Mexico Register, Volume XXIX, Issue 18, September 25, 2018, eff. 9/25/2018