PatientSignatureDateMissingWho isReceivingMissingAuth isPoorQualityPurposeofDisclosureMissingInformationto beDisclosedMissingExpirationDate/EventMissingRevocationStatementMissingAuth DOESNOT allowSensitiveInfoElectronicSignaturePatientIdentifierMismatchRe-DisclosureStatementMissingPatientSignatureMissingAuth inAnotherLanguageAuthNeededbut notProvidedSignatureDate inthe FutureConditioningStatementMissingPatientDirectiveWho isReleasingMissingSensitiveInformationMissingPoA orPersonalRepRequestorAddressdoes notmatchRequestMissingLetterof RepHIV/AIDSClauseMissingRequestedInfo differsfromAuthorizedInfoPatientSignatureDateMissingWho isReceivingMissingAuth isPoorQualityPurposeofDisclosureMissingInformationto beDisclosedMissingExpirationDate/EventMissingRevocationStatementMissingAuth DOESNOT allowSensitiveInfoElectronicSignaturePatientIdentifierMismatchRe-DisclosureStatementMissingPatientSignatureMissingAuth inAnotherLanguageAuthNeededbut notProvidedSignatureDate inthe FutureConditioningStatementMissingPatientDirectiveWho isReleasingMissingSensitiveInformationMissingPoA orPersonalRepRequestorAddressdoes notmatchRequestMissingLetterof RepHIV/AIDSClauseMissingRequestedInfo differsfromAuthorizedInfo

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