PatientDirectiveRevocationStatementMissingPatientIdentifierMismatchPatientSignatureMissingWho isReleasingMissingSignatureDate inthe FuturePatientSignatureDateMissingConditioningStatementMissingRe-DisclosureStatementMissingPurposeofDisclosureMissingPoA orPersonalRepAuth inAnotherLanguageRequestorAddressdoes notmatchRequestSensitiveInformationMissingWho isReceivingMissingElectronicSignatureAuth isPoorQualityInformationto beDisclosedMissingExpirationDate/EventMissingAuthNeededbut notProvidedAuth DOESNOT allowSensitiveInfoRequestedInfo differsfromAuthorizedInfoHIV/AIDSClauseMissingMissingLetterof RepPatientDirectiveRevocationStatementMissingPatientIdentifierMismatchPatientSignatureMissingWho isReleasingMissingSignatureDate inthe FuturePatientSignatureDateMissingConditioningStatementMissingRe-DisclosureStatementMissingPurposeofDisclosureMissingPoA orPersonalRepAuth inAnotherLanguageRequestorAddressdoes notmatchRequestSensitiveInformationMissingWho isReceivingMissingElectronicSignatureAuth isPoorQualityInformationto beDisclosedMissingExpirationDate/EventMissingAuthNeededbut notProvidedAuth DOESNOT allowSensitiveInfoRequestedInfo differsfromAuthorizedInfoHIV/AIDSClauseMissingMissingLetterof Rep

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