New Mexico Statutes Chapter 41. Torts § 41-5-15. Commission decision required; application

(1) the name of the health care provider against which the claims are asserted;

(2) a short and plain statement of the grounds as to why the New Mexico medical review commission has jurisdiction over the claims being asserted;

(3) the specific date or date range when the malpractice allegedly occurred;

(4) so far as known, a brief statement of the facts supporting the patient's malpractice claim; and

(5) a statement authorizing the panel to obtain access to all medical and hospital records and information pertaining to the matter giving rise to the application and, for the purposes of its consideration of the matter only, waiving any claim of privilege as to the contents of those records. Nothing in that statement shall in any way be construed as waiving that privilege for any other purpose or in any other context, in or out of court.