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