1. A. Requirements: The applicant shall present to the program, via mail or fax, a completed department application which is available on the department’s website at http://nmhealth.org/about/phd/fhb/mwp/or by contacting the program at (505) 476-8907. Along with the application the applicant must submit:

   1. (1) a copy of the applicant’s current New Mexico license to practice certified nurse-midwifery or medicine;
   2. (2) proof of the applicant’s current malpractice liability insurance policy premium covering birthing services;
   3. (3) proof of both the number and the percentage of medicaid and indigent patients seen in the applicant’s birthing practice in each of the previous two years;
   4. (4) proof of all payments and any funding the applicant received for delivery services for each of the previous two years; and
   5. (5) proof that the applicant provides both prenatal and birthing services in his/her practice.
2. B. Deadline for application: Deadline for application will be available through the program and will be listed on the application.

[7.30.9.9 NMAC - Rp, 7.30.9.9 NMAC, 6/30/2016]