Overview:  This form is part of  a collaborative site between several federal, state, and local New Mexico entities intended to connect New Mexico medical providers with solutions and capabilities from across the State. It is not intended to address individual medical needs. If you are in need of immediate medical attention or help, please call 911 or refer to other communication avenues as publicized by local, State or Federal entities

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* 2. Point of Contact

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* 5. We are in need of KN95 masks.  Please enter the amount needed below.  
(Note: These are non-NIOSH certified masks)

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* 6. What is the size of the group requesting KN95 masks for?

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* 9. If available, we will need these supplies and/or equipment by the following date:

Date

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* 10. Comments/Notes: (please consider using this space or the Attachment field below to provide any specific information that would help us better understand your needs, include quantities, sizes, specifications)

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* 11. Attachments - Use the file upload button below to provide further information related to your response.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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