Who isReceivingMissingExpirationDate/EventMissingPatientSignatureDateMissingConditioningStatementMissingWho isReleasingMissingRequestedInfo differsfromAuthorizedInfoAuth inAnotherLanguageSensitiveInformationMissingRevocationStatementMissingAuthNeededbut notProvidedSignatureDate inthe FutureRe-DisclosureStatementMissingInformationto beDisclosedMissingMissingLetterof RepPatientDirectiveAuth DOESNOT allowSensitiveInfoPatientSignatureMissingRequestorAddressdoes notmatchRequestAuth isPoorQualityPurposeofDisclosureMissingPatientIdentifierMismatchPoA orPersonalRepElectronicSignatureHIV/AIDSClauseMissingWho isReceivingMissingExpirationDate/EventMissingPatientSignatureDateMissingConditioningStatementMissingWho isReleasingMissingRequestedInfo differsfromAuthorizedInfoAuth inAnotherLanguageSensitiveInformationMissingRevocationStatementMissingAuthNeededbut notProvidedSignatureDate inthe FutureRe-DisclosureStatementMissingInformationto beDisclosedMissingMissingLetterof RepPatientDirectiveAuth DOESNOT allowSensitiveInfoPatientSignatureMissingRequestorAddressdoes notmatchRequestAuth isPoorQualityPurposeofDisclosureMissingPatientIdentifierMismatchPoA orPersonalRepElectronicSignatureHIV/AIDSClauseMissing

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