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 and Prairie Star Surgery Center


   Surgery Center Patient Pre-Registration


Shawnee Mission Health's Surgery Center has locations at Shawnee Mission Medical Center and Shawnee Mission Health - Prairie Star. Learn more. 

Shawnee Mission Surgery Center

On campus at Shawnee Mission Medical Center
9301 W. 74th Street, Suite 300
Merriam, KS 66204
Get Directions

Shawnee Mission Surgery Center Helpful Numbers:
  • Main Number: 913-632-9300
  • Pre-Surgery Department: 913-632-9333
  • Co-Payments or Co-Insurance Questions: 913-632-9324
  • Billing Questions or to Make a Payment: 913-676-7770

Prairie Star Surgery Center

On campus at Shawnee Mission Health - Prairie Star
23401 Prairie Star Parkway
Lenexa, KS 66227
Get Directions

Prairie Star Surgery Center Helpful Numbers:
  • Main Number: 913-676-8550
  • Pre-Surgery Department: 913-676-8553
  • Co-Payments or Co-Insurance Questions: 913-676-8591
  • Billing Questions or to Make a Payment: 913-676-7770

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


PLEASE NOTE:
  • If you have hit submit, and you do not get a thank you screen, your registration did not go through. Scroll up to see if there are required fields that were not completed.
  • You will see a thank you message and receive a confirmation email if your registration was submitted successfully.
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
Overland Park
7820 W. 165th Street
Overland Park, KS 66223
Get Directions

Main Number
913-373-1100