Authorization Bingo - Call List

(Print) Use this randomly generated list as your call list when playing the game. There is no need to say the BINGO column name. Place some kind of mark (like an X, a checkmark, a dot, tally mark, etc) on each cell as you announce it, to keep track. You can also cut out each item, place them in a bag and pull words from the bag.

1. Revocation Statement Missing
2. Re-Disclosure Statement Missing
3. Conditioning Statement Missing
4. Sensitive Information Missing
5. Patient Identifier Mismatch
6. Signature Date in the Future
7. Who is Receiving Missing
8. Auth DOES NOT allow Sensitive Info
9. Requested Info differs from Authorized Info
10. Missing Letter of Rep
11. Information to be Disclosed Missing
12. Purpose of Disclosure Missing
13. Expiration Date/Event Missing
14. Auth is Poor Quality
15. Auth in Another Language
16. Patient Signature Missing
17. Patient Signature Date Missing
18. Requestor Address does not match Request
19. Auth Needed but not Provided
20. PoA or Personal Rep
21. HIV/AIDS Clause Missing
22. Electronic Signature
23. Who is Releasing Missing
24. Patient Directive