Sachse

:: CLINIC INFORMATION

:: LOCATION

Family Medicine
5250 State Highway 78, Suite 850
Sachse, TX 75048

Phone - (972) 530-0978
Fax - (972) 530-0618

Hours
Monday - Friday 8 a.m. - 5 p.m.
Closed for lunch noon - 1 p.m.

Location Information
Directions from President George Bush Turnpike: Exit onto Lavon Dr./TX-78 N. toward Sachse/Wylie. We are located on the right hand side of the street between Bunker Hill Rd. and Ben Davis Rd. in the shopping center.

Map
Click here for an aerial map of this location and exact driving directions.

:: BIOGRAPHY - DR. JASON X. MEDINA

Jason X. Medina is Board Certified by the American Board of Family Medicine

Specialty		Medical School
Family Medicine		UT Southwestern Medical School Dallas, TX
Bachelor of Arts		Residency
The University of Texas Austin, Texas		Waco Family Medicine
Residence		Memberships
Dr Medina resides in Sachse with his family.		American Board of Family Medicine

:: FORMS

Adult New Patient
For adults (age 18+) with a new patient appointment
(Para obtener este formulario en español, por favor oprima aquí)

Pediatric New Patient
For children (age less than 18) with a new patient appointment
(Para obtener este formulario en español, por favor oprima aquí)

Receipt and Notice of Privacy Practices
Describes how medical information about you may be used and disclosed and how you can access this information. HIPAA requires all patients to complete this form.
(Para obtener este formulario en español, por favor oprima aquí)

Medical Release
Form authorizing healthcare provider to release your medical information to Lake Highlands Medical Partners
(Para obtener este formulario en español, por favor oprima aquí)

Red Flags Payment Permission Form
Form authorizing a patient the use of Medical Flex card, personal credit card, or personal check to pay for the services that they receive at Lake Pointe Medical Partners
(Para obtener este formulario en español, por favor oprima aquí)

Medical Information Release
Authorizes Lake Pointe Medical Partners to release your medical information to specific entities.
(Para obtener este formulario en español, por favor oprima aquí)

Frequently Asked Questions
HIPAA as it relates to our patients.
(Para obtener este formulario en español, por favor oprima aquí)

Financial Policy
Explains payment of services
(Para obtener este formulario en español, por favor oprima aquí)

Request for Correction / Amendment to Record
Allows you to request a correction / amendment to your medical record.
(Para obtener este formulario en español, por favor oprima aquí)

Know Your Benefits
This pamphlet can assist you in learning about your insurance benefits, including questions to ask your provider.
(Para obtener este formulario en español, por favor oprima aquí)

:: Services Offered

• New Patients Always Welcome

• Same-Day Sick Visits Available

• Accept Most Insurance Plans and Medicare

• Health Care for the Whole Family, Newborns and Older

• Sports, School, Annual Physicals

• Labs, Immunizations, Travel Medicine