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New Mexico Living Will AND/OR New Mexico Durable Power of Attorney

(In compliance with the Patient Self-determination Act 1990)

Patient Self-determination Information Verification

If yes, complete the following information:

Information on Individual with Durable Power of Attorney and/or Living Will for Health Care Decisions:

If yes, place a copy of LIVING WILL (Right to Die) and/or DURABLE POWER of ATTORNEY for healthcare decisions in medical record.

If no, information concerning advance medical directives, including information describing the DURABLE POWER of ATTORNEY and LIVING WILLS has been given to this patient.

This health center receives HHS funding and has Federal Public Health (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

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Contact Us

To make an appointment, please contact one of our convenient locations...

Portales: (575) 356-6695
ENMU: (575) 562-2321
Clovis: (575) 769-0888
Roswell: (575) 623-3255
Roswell Pediatrics: (575) 622-5956
ENMU Roswell: (575) 624-7106
Roswell Behavioral: (575) 755-2272