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