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SRC Palliative Care Clinical Privileges Name: Effective Dates: ___ To: ___All new applicants must meet the following requirements as approved by the UNM Sandoval Regional Medical Center, Inc. Governing
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Obtain the necessary forms from the UNM Sandoval Regional Medical Center or download them from their website.
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Fill out the forms completely and accurately with your personal information, medical history, and any other required details.
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Submit the completed forms along with any required fees to the appropriate department at UNM Sandoval Regional Medical Center.

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Patients seeking specialized care or procedures offered by the medical center.
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Visitors or family members seeking information or support related to a patient receiving care at the facility.
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UNM Sandoval Regional Medical Center is a healthcare facility affiliated with the University of New Mexico offering a range of medical services.
Patients who receive medical services at UNM Sandoval Regional Medical Center may be required to provide information for billing and insurance purposes.
Patients can fill out UNM Sandoval Regional Medical forms provided by the facility or online portal with accurate and complete information about their health history and medical services received.
The purpose of UNM Sandoval Regional Medical forms is to gather necessary information for patient care, billing, and insurance purposes to ensure comprehensive and accurate medical records.
Information such as personal details, insurance information, medical history, and details of services received at UNM Sandoval Regional Medical Center must be reported on the forms.
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