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