PatientDirectiveWho isReleasingMissingRe-DisclosureStatementMissingAuth inAnotherLanguagePatientSignatureDateMissingSensitiveInformationMissingExpirationDate/EventMissingAuth DOESNOT allowSensitiveInfoHIV/AIDSClauseMissingPatientSignatureMissingInformationto beDisclosedMissingAuth isPoorQualityAuthNeededbut notProvidedRevocationStatementMissingElectronicSignaturePatientIdentifierMismatchRequestedInfo differsfromAuthorizedInfoPurposeofDisclosureMissingSignatureDate inthe FutureRequestorAddressdoes notmatchRequestConditioningStatementMissingPoA orPersonalRepMissingLetterof RepWho isReceivingMissingPatientDirectiveWho isReleasingMissingRe-DisclosureStatementMissingAuth inAnotherLanguagePatientSignatureDateMissingSensitiveInformationMissingExpirationDate/EventMissingAuth DOESNOT allowSensitiveInfoHIV/AIDSClauseMissingPatientSignatureMissingInformationto beDisclosedMissingAuth isPoorQualityAuthNeededbut notProvidedRevocationStatementMissingElectronicSignaturePatientIdentifierMismatchRequestedInfo differsfromAuthorizedInfoPurposeofDisclosureMissingSignatureDate inthe FutureRequestorAddressdoes notmatchRequestConditioningStatementMissingPoA orPersonalRepMissingLetterof RepWho isReceivingMissing

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.


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