(a) Crime. As used in these rules, a crime for which discipline may be imposed is any
felony, i.e., a crime punishable by a term of imprisonment of more than one year; any
lesser crime that reflects adversely on the honesty, trustworthiness or fitness of the
attorney in other respects; or any crime a necessary element of which, as determined
by the statutory or common law definition of the crime, involves interference with the
administration of justice, false swearing, misrepresentation, fraud, deceit, bribery,
extortion, misappropriation, theft, or an attempt, conspiracy or solicitation to commit
a crime.
(b) Conviction. As used in these rules, a conviction includes a verdict of guilty, a plea
of guilty, or a plea of nolo contendere, regardless of whether entry of judgment of
conviction or imposition of sentence is suspended or deferred by the court.
(c) Duty of the Clerk. After receiving notice of a conviction of a member of the bar of
this court for a crime as defined in subdivision (a), the clerk must immediately notify
the Chief Judge and the attorney.
(d) Interim Suspension.
(1) General Procedure. The Chief Judge may place an attorney on interim
suspension immediately on proof of a conviction of the attorney for a crime as
defined in subdivision (a), regardless of the pendency of any appeal.
Alternatively, the Chief Judge may refer the attorney to a panel of judges for
investigation and recommendation pursuant to D.N.M.LR-Civ.83.10(a).
(2) Opportunity to Object. The attorney may submit in writing any objection
that establishes that the suspension may not properly be ordered, such as proof
that the crime did not constitute a crime as defined in subdivision (a) or that
the attorney is not the individual convicted.
(3) Termination. On a written showing by the attorney of extraordinary
circumstances, the Chief Judge may vacate an order of suspension.
(4) Effect of Reversal or Vacatur of Conviction. With the exception of a
guilty plea resulting in a deferred judgment or sentence, if an attorney
suspended under this rule demonstrates that the underlying conviction has
been reversed or vacated, the order of interim suspension shall be vacated and
the attorney reinstated. The vacatur of the interim suspension does not
automatically terminate any disciplinary proceeding then pending against the
attorney.
(e) Formal Charges. When the conviction for a crime as defined in subdivision (a) is
the result of a guilty verdict, on conclusion of direct appeal, the Clerk of the Court
must submit formal charges to the Chief Judge. The Chief Judge will appoint a panel
of judges pursuant to D.N.M.LR-Civ. 83.10(a) to determine the nature and extent of
the discipline to be imposed.
(f) Other Grounds for Discipline. Notwithstanding the disposition of criminal
charges, the panel of judges may consider the underlying facts to determine if
disciplinary proceedings are warranted.
LOCAL FORM 1
HIPAA
AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION
MEDICAL RECORDS
THIS DOCUMENT DOES NOT AUTHORIZE RELEASE OF ANY RECORDS CONCERNING
OR RELATED TO ANY ALCOHOL, DRUG, HIV OR PSYCHIATRIC CARE, TESTING OR TREATMENT
Patient name: ____________________ D.O.B.: ___/___/___ S.S.N.: _____________
Dates of Treatment: beginning _______ through ________
[relevant time period must be inserted]
AUTHORIZATION:
I, _____________________________________, authorize the disclosure of my protected
health information as described herein.
1. I authorize the following person(s) and/or organization(s) to disclose the protected
health information described in paragraph 3.
[individual medical provider name must be inserted]
2. I authorize the following person(s) and/or organization(s) to receive the protected
health information described in paragraph 3.
[individual firm or lawyer must be inserted]
3. The records authorized to be released include:
all medical records and billing records including without limitation: medical reports,
clinical notes, nurse=s notes, history of injury, subjective and objective complaints,
(USDC, DNM Local Form 1, Page 1)
x-rays, x-ray reports or interpretations, other diagnostic tests (including a copy of
the report), diagnosis and prognosis; if applicable, emergency room records or
logs, history and physical examination report, laboratory reports, tissue
committee reports, reports of operation, operation logs, progress notes, doctors=
orders, nurse=s notes, physical therapy records, admission and discharge
summaries, and all out-patient records; hospital bills, bills for the services you
have rendered, bills for medication; and any other documents, records, or
information in your possession relative to my past, present or future physical
condition.
4. I expressly waive any laws, regulations and rules of ethics which might prevent
any health care provider who has examined or treated me from disclosing my
records pursuant to this Authorization.
5. The purpose of this Authorization relates to a legal action now pending in the
United States District Court for the District of New Mexico.
6. I understand that I may revoke this Authorization at any time by sending a letter
to the person or organization listed in paragraph one (1), except to the extent that
such person(s) and/or organization(s) may have already taken action in reliance
on this Authorization. If I do not sign, or if I later revoke, this Authorization, the
services provided to me by such person or organization will not be affected in
any way.
7. This Authorization expires one year from its date of execution.
8. THIS AUTHORIZATION PER SE DOES NOT PERMIT THE PERSON OR
ORGANIZATION LISTED IN PARAGRAPH TWO (2) TO OBTAIN OR REQUEST
FROM THE MEDICAL PROVIDER IDENTIFIED IN PARAGRAPH ONE (1)
ORAL STATEMENTS, OPINIONS, INTERVIEWS, OR REPORTS THAT ARE
NOT ALREADY IN EXISTENCE. HOWEVER, THIS AUTHORIZATION DOES
NOT PROHIBIT THE MEDICAL PROVIDER FROM GIVING A DEPOSITION
UNDER THE FEDERAL RULES OF CIVIL PROCEDURE.
9. Copying costs will be borne by the person or organization named in paragraph
two (2).
10. A photocopy or facsimile of this Authorization is as valid as an original.
11. I understand that a potential exists for information that is disclosed pursuant to
this Authorization to be subject to re-disclosure by the recipient and therefore be
no longer protected by federal confidentiality rules.
SIGNATURE OF PATIENT OR
AUTHORIZED REPRESENTATIVE:
CAPACITY OF REPRESENTATIVE,
IF APPLICABLE:
(USDC, DNM Local Form 1, Page 2)
DATE OF SIGNATURE: _____________________________________
(USDC, DNM Local Form 1, Page 3)
LOCAL FORM 2
HIPAA
AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION
MENTAL HEALTH RECORDS
Patient name: ____________________ D.O.B.: ___/___/___ S.S.N.: _____________
Dates of Treatment: beginning _______ through ________
[relevant time period must be inserted]
AUTHORIZATION:
I, _____________________________________, authorize the disclosure of my
protected health information as described herein.
1. I authorize the following person(s) and/or organization(s) to disclose the
protected health information described in paragraph 3.
[individual medical provider name must be inserted]
2. I authorize the following person(s) and/or organization(s) to receive the protected
health information described in paragraph 3.
[individual firm or lawyer must be inserted]
3. The records authorized to be released include:
[ ] complete copy of medical records
[ ] test results
[ ] other
(USDC, DNM Local Form 2, Page 1)
4. I expressly waive any laws, regulations and rules of ethics which might prevent
any health care provider who has examined or treated me from disclosing my
records pursuant to this Authorization.
5. The purpose of this Authorization relates to a legal action now pending in the
United States District Court for the District of New Mexico.
6. I understand that I may revoke this Authorization at any time by sending a letter
to the person or organization listed in paragraph one (1), except to the extent that
such person(s) and/or organization(s) may have already taken action in reliance
on this Authorization. If I do not sign, or if I later revoke, this Authorization, the
services provided to me by such person or organization will not be affected in
any way.
7. This Authorization expires one year from its date of execution.
8. THIS AUTHORIZATION PER SE DOES NOT PERMIT THE PERSON OR
ORGANIZATION LISTED IN PARAGRAPH TWO (2) TO OBTAIN OR REQUEST
FROM THE MEDICAL PROVIDER IDENTIFIED IN PARAGRAPH ONE (1)
ORAL STATEMENTS, OPINIONS, INTERVIEWS OR REPORTS THAT ARE
NOT ALREADY IN EXISTENCE. HOWEVER, THIS AUTHORIZATION DOES
NOT PROHIBIT THE MEDICAL PROVIDER FROM GIVING A DEPOSITION
UNDER THE FEDERAL RULES OF CIVIL PROCEDURE.
9. Copying costs will be borne by the person or organization named in paragraph
two (2).
10. A photocopy or facsimile of this Authorization is as valid as an original.
11. I understand that I have a right to examine the information to be disclosed,
unless deemed that such disclosure is not in my best interest.
12. I understand that a potential exists for information that is disclosed pursuant to
this Authorization to be subject to re-disclosure by the recipient and therefore be
no longer protected by federal confidentiality rules.
SIGNATURE OF PATIENT OR
AUTHORIZED REPRESENTATIVE:
CAPACITY OF REPRESENTATIVE,
IF APPLICABLE:
DATE OF SIGNATURE: _____________________________________
(USDC, DNM Local Form 2, Page 2)
