ExpirationDate/EventMissingPurposeofDisclosureMissingPatientSignatureMissingRequestedInfo differsfromAuthorizedInfoConditioningStatementMissingAuth isPoorQualityHIV/AIDSClauseMissingWho isReleasingMissingSensitiveInformationMissingWho isReceivingMissingPoA orPersonalRepAuth DOESNOT allowSensitiveInfoRequestorAddressdoes notmatchRequestPatientDirectivePatientIdentifierMismatchElectronicSignatureInformationto beDisclosedMissingAuthNeededbut notProvidedAuth inAnotherLanguageSignatureDate inthe FutureMissingLetterof RepRe-DisclosureStatementMissingRevocationStatementMissingPatientSignatureDateMissingExpirationDate/EventMissingPurposeofDisclosureMissingPatientSignatureMissingRequestedInfo differsfromAuthorizedInfoConditioningStatementMissingAuth isPoorQualityHIV/AIDSClauseMissingWho isReleasingMissingSensitiveInformationMissingWho isReceivingMissingPoA orPersonalRepAuth DOESNOT allowSensitiveInfoRequestorAddressdoes notmatchRequestPatientDirectivePatientIdentifierMismatchElectronicSignatureInformationto beDisclosedMissingAuthNeededbut notProvidedAuth inAnotherLanguageSignatureDate inthe FutureMissingLetterof RepRe-DisclosureStatementMissingRevocationStatementMissingPatientSignatureDateMissing

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