Lordsburg: Hidalgo County COVID-19 Community ClinicAddress: 109 Poplar Street Lordsburg, NM 88045
Silver City: Grant County COVID-19 Community ClinicAddress: 1304 E 32nd Street, Silver City, NM 88061
I hereby give Hidalgo Medical Services (HMS) consent to conduct COVID-19 testing. The test detects if you
have SARS-CoV-2 (the virus that causes COVID-19) at the time of the test only. It does not test for immunity
or if you had the virus in the past. I authorize HMS to contact me via phone at the number listed above for test
results. I understand that my results will be reported to the New Mexico Department of Health for tracking and
contact tracing purposes. I authorize HMS to release all information necessary to secure payment of benefits
from my insurance company.
If my test results come back positive, my Primary Care Provider (PCP) will be notified.
Please fill out all fields as accurately and completely as possible. If you have any questions or need help you can call HMS at 888-271-3596.
All information collected will be kept confidential and in accordance with HIPPA regulations.