After days, maybe even weeks, of meeting with your physician and pouring over every question related to your procedure, the last thing you need is a sea of paperwork to generate more uncertainties. That's why we've worked to keep the registration process as simple and uncluttered as it can possibly be. On this page, you'll find all of the documents you need to generate your medical history, give consent for the scheduled procedure and provide relevant insurance information.
Saint Luke's Surgicenter is proud to offer their patients the convenience of One Medical Passport, which allows them to complete medical forms before walking through the door.
Simply access a secure website and complete your Medical Passport (demographic, insurance and medical history). The completed medical history will be automatically formatted into comprehensive Operating Room forms.
It can be unnerving to share the entirety of your medical history with anyone, even a recognized facility like ours. Rest assured, your personal information and patient data are protected according to all federal HIPAA laws and regulations.
Please bring your Insurance Card(s) and Photo ID Upon arrival you will be asked to review and complete Admitting department documents, and acknowledge receipt of the following information provided below:
The physician who referred you to this facility may have an ownership interest in this facility. You are free to choose another facility in which to receive the services that have been ordered by your physician.
This facility is dedicated to the protection of your personal health information. We follow the guidelines set forth by the U.S. Depart of Health & Human Services, Office of Civil Rights. You can visit their website for more information: http://www.hhs.gov/ocr/hipaa/.
We are required by Federal law to provide all patients, patient representatives or surrogates with written information concerning the Facility’s policies on advance directives, including a description of applicable State health and safety laws and, if requested, official State advance directive forms. We also must inform you, your representative or surrogate, of your right to make informed decisions regarding your care.
(42 C.F.R. § 416.50 (c))
There are several types of advance directives. The two most common forms are living wills and durable power of attorney designation (Click here to download a durable power of attorney document). All patients have the right to participate in their own healthcare decisions and to make advance directives or execute powers of attorney that authorize others to make decisions on their behalf. If you would like information on developing advance directives, the following website can assist you and includes a description of the State’s health and safety laws: http://www.uslivingwillregistry.com/forms.shtm.
Saint Luke’s Surgicenter – Lee’s Summit will honor the intent of the advance directive to the extent permitted by law, and subject to the limitations on the basis of conscience. However, this Facility performs elective procedures that generally enhance or improve the patient’s quality of life. Therefore, in the event of a medical emergency, it is the policy of this Facility to initiate resuscitative measures and transfer the patient to a hospital for further evaluation. At the hospital, further treatment or withdrawal of treatment measures may be exercised in accordance with the patient’s advance directive. If you do not agree with this policy, please address this issue with your physician prior to the procedure.
This facility does not discriminate against any person on the basis of age, sex, race, color, religion, national origin, or disability in admission, treatment, or participation in its programs, services and activities or in employment.