Medication List

Forms

Internal Medicine - Primary Care

​Patient Assistance Program for Prescription Drugs

Blood Pressure Log

Handouts

Diabetes Prevention (Wichita County Public Health District)

My Time - Record Personal Info and Wishes (Hospice of Wichita Falls)

​​Privacy Notices & Patient Rights (HIPAA)

Vaccine Information Statement (VIS) - Multi Language

Notice of Privacy Practices

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Shingles Vaccine - What You Need to Know

New Patient Registration Form

FMLA:  Family and Medical Leave Act (Dept. of Labor)

Low Cholesterol Diet Plan

Potassium Foods  - Low

Kegel Exercise for Men (Ohio State University)

Advance Directives "Living Will" (United Regional)

​Medical Records Release to Dr. Myrna C. De Asis

Employment Application

​​​Immunization Schedule for Adults (CDC)

Noticia de Practicas Privadas

Purine Restricted Diet

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Good Faith Estimate on Medical Cost

Disclaimer

Kegel Exercise for Women (Ohio State University)

Do Not Resuscitate (Texas Dept of State Health Services)

Fasting Blood Sugar Log

Medical Power of Attorney (Texas Medical Association)

Texas Notifiable Conditions - 2024

Healthcare Directives

Potassium Foods - High

​​Myrna C. De Asis, M.D., P.A.​

Medical Records Release from us to another provider

1800 Calorie Meal Plan (Novo Nordisk)

Diabetes Education (Wichita County Public Health District)

Cologuard easy-to-use Colon Cancer Screening Test

Call Us:  (940) 763-8077