Electronic Signature Who is Receiving Missing Missing Letter of Rep HIV/AIDS Clause Missing Information to be Disclosed Missing Requestor Address does not match Request Auth is Poor Quality Auth in Another Language Purpose of Disclosure Missing Signature Date in the Future Patient Signature Missing Sensitive Information Missing Re- Disclosure Statement Missing Expiration Date/Event Missing PoA or Personal Rep Auth DOES NOT allow Sensitive Info Who is Releasing Missing Patient Signature Date Missing Auth Needed but not Provided Requested Info differs from Authorized Info Conditioning Statement Missing Patient Directive Patient Identifier Mismatch Revocation Statement Missing Electronic Signature Who is Receiving Missing Missing Letter of Rep HIV/AIDS Clause Missing Information to be Disclosed Missing Requestor Address does not match Request Auth is Poor Quality Auth in Another Language Purpose of Disclosure Missing Signature Date in the Future Patient Signature Missing Sensitive Information Missing Re- Disclosure Statement Missing Expiration Date/Event Missing PoA or Personal Rep Auth DOES NOT allow Sensitive Info Who is Releasing Missing Patient Signature Date Missing Auth Needed but not Provided Requested Info differs from Authorized Info Conditioning Statement Missing Patient Directive Patient Identifier Mismatch Revocation Statement Missing
(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.
Electronic Signature
Who is Receiving
Missing
Missing Letter of Rep
HIV/AIDS Clause Missing
Information to be Disclosed Missing
Requestor Address does not match Request
Auth is Poor Quality
Auth in Another Language
Purpose of Disclosure Missing
Signature Date in the Future
Patient Signature
Missing
Sensitive Information Missing
Re-Disclosure Statement
Missing
Expiration Date/Event
Missing
PoA or Personal Rep
Auth DOES NOT allow Sensitive Info
Who is Releasing Missing
Patient Signature Date
Missing
Auth Needed but not Provided
Requested Info differs from Authorized Info
Conditioning Statement
Missing
Patient Directive
Patient Identifier Mismatch
Revocation Statement Missing