Los Amigos NM

Mi Via Forms

Download the Mia Via forms by clicking the buttons below. We are happy to be assisting you through the process. From time to time, you will be asked to download certain forms, complete them and either fax them or email them to your customer service person.

Mi Via Service Standards
Medicaid Application for Assistance: English
Medicaid Application for Assistance Spanish
DDSD Staff Home Visit Safety Checklist
DDSD Wellness Visits Update: September 21 2023
Mi Via Level of Care Renewal Documents
Los Amigos ANE Guidebook: English
Los Amigos ANE Guidebook: Spanish
Abuse, Neglect, and Exploitation Reporting Information Poster
Abuse, Neglect, and Exploitation Reporting Information Cards: English
Abuse, Neglect, and Exploitation Reporting Information Cards: Spanish
MV LRI FORM
Mi Via EMOD Checklist
Person Centered Fact Sheet
Service and Support Plan SSP
Palco EMPLOYEE Packet
Mileage Form Employee
Palco Employee Transportation Appendix
Payment Request Form
EVV Information Session
Palco Vendor Packet
Vendor Credentialing Requirements
Palco Transition EOR Packet
Palco EOR Packet: Full Packet
Service-Activity Codes
EVV FORUM 12-21-2020 QUESTIONS AND ANSWERS
AuthentiCare Palco New Mexico User Guide
DOH Incident Management Bureau Annual Report 2023
Incident Management Bureau Abuse, Neglect, and Exploitation Reporting System
Abuse Neglect and Exploitation Reporting Guide 2021
Abuse Neglect and Exploitation Reporting Guide 2021 Spanish
Instructions for Consultants
Emergency Backup Plan Revised
CMS Final Rule - Provider Validation Re-do
No EOR: Application for Authorization to Sign Vendor Agreements and Payment Request Forms
2020 Mi Via Waiver Renewal Town Hall Presentation
Final Rule Requirements For Home and Community Settings
Self-Direction: Fact Sheet
Know Your Rights Letter
Provider Attestation Form
EOR Fact Sheet
Final Rule exploratory-questions-non-residential

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