Your Account
close button

Use our patient tools for secure, convenient, 24/7 access. Learn more

This facility is a member of

Shawnee Mission Surgery Center


   

   Surgery Center Patient Pre-Registration


Get Directions: Shawnee Mission Surgery Center at Shawnee Mission Medical Center
or call 913-632-9300.

Other Helpful numbers:

Pre-Surgery Department: 913-632-9333
Co-payments or co-insurance questions: 913-632-2324
Billing questions, or to make a payment on your account: 913-676-7769
Technical problems with your online pre-registration: 913-676-2062

Get Directions: Shawnee Mission Surgery Center at Prairie Star

913-676-8550
 

Surgery Pre-Registration

General Information


Patient Information


Emergency Contacts


Name of responsible adult with you day of surgery (if having anesthesia)
Is it OK to share any medical information and/or home instructions with this person?

Medical Information


List any surgeries/major illnesses (including cancer) you have had and approximate date
Have you or a blood relative ever had a complication/reaction from anesthesia?
(fever, malignant hyperthermia, difficulty awakening, nausea, airway complications)
List any ALLERGIES to medications, iodine/contrast dye, latex, tape or food. Include reaction.
List the medications you are currently taking, the dose and time of day you take them.
Check if you have ever had any of the following:










































Are you in an abusive situation or do you lack support?



Women Only


Submit
* Required
SHAWNEE MISSION HEALTH LOCATIONS
Shawnee Mission Medical Center
9100 West 74th Street
Shawnee Mission, Kansas 66204
Get Directions

Main Number
913-676-2000
Prairie Star
23401 Prairie Star Parkway
Lenexa, Kansas 66227
Get Directions

Main Number
913-676-8500